Provider Demographics
NPI:1760613962
Name:SORENSON, CAREY LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAREY
Middle Name:LYNN
Last Name:SORENSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-6518
Mailing Address - Country:US
Mailing Address - Phone:414-841-6052
Mailing Address - Fax:
Practice Address - Street 1:1309 S ONEIDA ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1351
Practice Address - Country:US
Practice Address - Phone:414-841-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3407 - 57103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling