Provider Demographics
NPI:1376185124
Name:SORENSEN, KRISTINA (PSYD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 W PETERSON AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5728
Mailing Address - Country:US
Mailing Address - Phone:847-329-9210
Mailing Address - Fax:773-347-2656
Practice Address - Street 1:5215 N CALIFORNIA AVE STE F607
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-8564
Practice Address - Country:US
Practice Address - Phone:847-329-9210
Practice Address - Fax:773-347-2656
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010134103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical