Healthcare Provider Details

I. General information

NPI: 1083495923
Provider Name (Legal Business Name): EMMA SORNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21440 SE STARK ST
GRESHAM OR
97030-2024
US

IV. Provider business mailing address

211 SE 126TH AVE APT 8
PORTLAND OR
97233-1063
US

V. Phone/Fax

Practice location:
  • Phone: 971-610-5722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24-12-11351
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: