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NPI Code Detail

MEDICARE: ROBERTA SORENSON LPCC

MEDICARE:   ROBERTA  SORENSON  LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor01430MN

General Provider Information

NPI Number : 1548624026
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERTA SORENSON LPCC
Provider Business Mailing Address
First Line : 1381 HEWITT AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-1306
Country : US
Telephone Number : 218-370-7978
Fax Number :
Provider Business Practice Location Address
First Line : 1381 HEWITT AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-1306
Country : US
Telephone Number : 218-370-7978
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2016
Last Update Date : 03/17/2018

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Directions to “ ROBERTA SORENSON LPCC” Practice Location

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