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General NPI Number Information
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NPI Number | 1285924035
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Entity Type | Organization
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Legal Business Name | ELIZABETH A SORENSON PHD
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 04/14/2011
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Provider Practice Location Address
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Address Line | 2725 PACKARD ST STE 102
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City | ANN ARBOR
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State | MI
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Zip | 48108-3443
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Country | US
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Telephone | 734-417-7450
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Fax |
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Provider Business Mailing Address
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Address Line | 4069 PONTIAC TRL
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City | ANN ARBOR
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State | MI
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Zip | 48105-9626
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Country | US
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Telephone | 734-417-7450
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | ELIZABETH A SORENSON
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Credential | PH.D
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Telephone | 734-417-7450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301008589
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License Number State | MI
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