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General NPI Number Information
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NPI Number | 1780738617
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Entity Type | Individual
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Provider Name | MARTHA JEAN SORENSEN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 5901 MAJESTIC ST
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City | FREDERICK
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State | CO
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Zip | 80504-6933
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Country | US
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Telephone | 970-347-2120
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 N 17TH AVE
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City | GREELEY
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State | CO
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Zip | 80631-9584
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Country | US
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Telephone | 970-347-2120
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Fax | 970-300-3127
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 2057
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY2057
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License Number State | CO
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