Healthcare Provider Details

I. General information

NPI: 1396512182
Provider Name (Legal Business Name): SHALA SORENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 W 4100 S
WEST VALLEY CITY UT
84120-5543
US

IV. Provider business mailing address

331 S RIO GRANDE ST STE 200
SALT LAKE CITY UT
84101-1137
US

V. Phone/Fax

Practice location:
  • Phone: 801-565-6900
  • Fax:
Mailing address:
  • Phone: 801-485-8051
  • Fax: 801-485-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberF24-110732
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: