Provider Demographics
NPI:1679103378
Name:SORENSON, DESIREE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:SORENSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 281859
Mailing Address - Street 2:
Mailing Address - City:LAMOILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89828-1859
Mailing Address - Country:US
Mailing Address - Phone:801-367-2627
Mailing Address - Fax:
Practice Address - Street 1:2052 HOGTOMMY ROAD
Practice Address - Street 2:
Practice Address - City:LAMOILLE
Practice Address - State:NV
Practice Address - Zip Code:89828-1859
Practice Address - Country:US
Practice Address - Phone:801-367-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-2684235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist