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General NPI Number Information
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NPI Number | 1609683614
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Entity Type | Individual
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Provider Name | NICOLE SORENSON
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Gender | Female
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 37200 N GANTZEL RD STE 150
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-7383
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Country | US
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Telephone | 520-484-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 1829 W STEPHANIE LN
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City | QUEEN CREEK
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State | AZ
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Zip | 85144-5812
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Country | US
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Telephone | 602-206-5275
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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