Provider Demographics
NPI:1447404306
Name:LABERGE-SORUM, JENNIFER DANIELLE (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DANIELLE
Last Name:LABERGE-SORUM
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0609
Mailing Address - Country:US
Mailing Address - Phone:605-332-4401
Mailing Address - Fax:
Practice Address - Street 1:2115 S PENDAR LN
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-3944
Practice Address - Country:US
Practice Address - Phone:605-359-3842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0216174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist