Healthcare Provider Details

I. General information

NPI: 1760613962
Provider Name (Legal Business Name): CAREY LYNN SORENSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 S ONEIDA ST
APPLETON WI
54915-1351
US

IV. Provider business mailing address

1709 CARRIAGE LN
APPLETON WI
54914-6518
US

V. Phone/Fax

Practice location:
  • Phone: 414-841-6052
  • Fax:
Mailing address:
  • Phone: 414-841-6052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3407 - 57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: