Provider Demographics
NPI:1013071331
Name:SORENSEN, ERIK D (PHD)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:D
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3608
Mailing Address - Country:US
Mailing Address - Phone:541-345-8749
Mailing Address - Fax:541-344-7595
Practice Address - Street 1:511 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3608
Practice Address - Country:US
Practice Address - Phone:541-345-8749
Practice Address - Fax:541-344-7595
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1259103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORS88637Medicare UPIN
OR105024Medicare ID - Type Unspecified