Provider Demographics
NPI:1508338781
Name:SORENSEN, JENNIFER ASHLEY (CMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ASHLEY
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ASHLEY
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMHC
Mailing Address - Street 1:256 N MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1477
Mailing Address - Country:US
Mailing Address - Phone:385-265-2577
Mailing Address - Fax:
Practice Address - Street 1:256 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-1477
Practice Address - Country:US
Practice Address - Phone:385-265-2577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9294602-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health