Provider Demographics
NPI:1053047431
Name:SORG, JENNIFER (PRSS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SORG
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CHAPLINE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2999
Mailing Address - Country:US
Mailing Address - Phone:304-232-0511
Mailing Address - Fax:304-232-0513
Practice Address - Street 1:1100 CHAPLINE ST FL 1
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2999
Practice Address - Country:US
Practice Address - Phone:304-232-0511
Practice Address - Fax:304-232-0513
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14-936175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist