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NPI Code Detail

MEDICARE: TRACY DENNIS SORENSEN

MEDICARE: TRACY DENNIS 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
1101Y00000XCounselor286011-6004UT

General Provider Information

NPI Number : 1710123211
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY DENNIS SORENSEN
Provider Business Mailing Address
First Line : 655 E 1300 N
Second Line :
City : LOGAN
State : UT
Zip : 84341-2570
Country : US
Telephone Number : 435-792-6491
Fax Number :
Provider Business Practice Location Address
First Line : 655 E 1300 N
Second Line :
City : LOGAN
State : UT
Zip : 84341-2570
Country : US
Telephone Number : 435-792-6491
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2009
Last Update Date : 01/05/2009

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Directions to “ TRACY DENNIS SORENSEN ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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