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NPI Code Detail

MEDICARE: MR. DANIEL ELDON SORENSEN LCSW

MEDICARE: MR. DANIEL ELDON SORENSEN LCSW
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
11041C0700XClinical Social Worker350423-3501UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
179919OTHERUTPEHP

General Provider Information

NPI Number : 1932205911
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DANIEL ELDON SORENSEN LCSW
Provider Business Mailing Address
First Line : 3505 S HIGHWAY 89
Second Line :
City : WELLSVILLE
State : UT
Zip : 84339-9748
Country : US
Telephone Number : 435-787-8447
Fax Number : 435-752-7433
Provider Business Practice Location Address
First Line : 90 E 200 N
Second Line :
City : LOGAN
State : UT
Zip : 84321-4034
Country : US
Telephone Number : 435-752-0750
Fax Number : 435-752-7433
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2006
Last Update Date : 07/08/2007

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