Provider Demographics
NPI:1083995898
Name:SORMRUD, SHARON J (SAC-IT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:J
Last Name:SORMRUD
Suffix:
Gender:F
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5184
Mailing Address - Country:US
Mailing Address - Phone:715-834-1078
Mailing Address - Fax:715-834-1218
Practice Address - Street 1:2000 N OXFORD AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5184
Practice Address - Country:US
Practice Address - Phone:715-834-1078
Practice Address - Fax:715-834-1218
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16246-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)