Provider Demographics
NPI:1346860228
Name:SORENSON, SARA JEAN (CMHC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JEAN
Last Name:SORENSON
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14133 S SENIOR BAND RD
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7515
Mailing Address - Country:US
Mailing Address - Phone:801-556-3308
Mailing Address - Fax:
Practice Address - Street 1:12608 S 125 W STE E
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8437
Practice Address - Country:US
Practice Address - Phone:385-213-9969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9668501-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health