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General NPI Number Information
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NPI Number | 1699810457
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Entity Type | Individual
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Provider Name | ERIC KRISTEN SORENSEN MS, LPC
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 405 LAKE SHORE DR E
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City | ASHLAND
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State | WI
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Zip | 54806-1837
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Country | US
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Telephone | 705-682-3523
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Fax | 715-682-3526
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Provider Business Mailing Address
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Address Line | 64123 LIPPO RD
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City | MARENGO
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State | WI
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Zip | 54855-3506
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Country | US
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Telephone | 715-278-3335
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3460 - 125
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License Number State | WI
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