Provider Demographics
NPI:1245570308
Name:SORENSEN-KOWALSKI, CAITLYN BRIANNE (PHD, LP, BCBA-LBA)
Entity Type:Individual
Prefix:DR
First Name:CAITLYN
Middle Name:BRIANNE
Last Name:SORENSEN-KOWALSKI
Suffix:
Gender:F
Credentials:PHD, LP, BCBA-LBA
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:BRIANNE
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LP, BCBA-LBA
Mailing Address - Street 1:910 HILLSIDE CT
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2138
Mailing Address - Country:US
Mailing Address - Phone:586-453-1297
Mailing Address - Fax:
Practice Address - Street 1:18471 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-8513
Practice Address - Country:US
Practice Address - Phone:248-735-5928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-13-13053103K00000X
MI6301018402103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst