Provider Demographics
NPI:1598284317
Name:SORENSEN, MARK STEVEN (HIS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 33RD ST STE 8
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-7632
Mailing Address - Country:US
Mailing Address - Phone:712-336-4327
Mailing Address - Fax:
Practice Address - Street 1:2230 33RD ST STE 8
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-7632
Practice Address - Country:US
Practice Address - Phone:712-336-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081731237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist