Provider Demographics
NPI:1861669772
Name:SORENSEN, TONY JOHN (PSYD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:JOHN
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S. MINNESOTA AVE.
Mailing Address - Street 2:STE. 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-3762
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:
Practice Address - Street 1:4400 W 69TH ST
Practice Address - Street 2:STE. 500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8171
Practice Address - Country:US
Practice Address - Phone:605-322-7580
Practice Address - Fax:605-322-7579
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4918103TC0700X
SD523103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical