MEDICARE: NICHOLE SORENSEN

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1578401956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE SORENSEN

Provider Business Mailing Address
First Line	:	3652 OGDEN AVE
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-1730
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1890 W ALEXANDER ST
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-2037
Country	:	US
Telephone Number	:	208-908-8923
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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Directions to “ NICHOLE SORENSEN ” Practice Location

Language	Start Address	Practice Location

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