Provider Demographics
NPI:1114642543
Name:SORENSEN, MEREDITH (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 SEAGLER RD APT 126
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2071
Mailing Address - Country:US
Mailing Address - Phone:989-255-6195
Mailing Address - Fax:
Practice Address - Street 1:1202 SEAGLER RD APT 126
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2071
Practice Address - Country:US
Practice Address - Phone:989-255-6195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered