Provider Demographics
NPI:1184401358
Name:LOKHORST, SONJA KELSEY (MA)
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:KELSEY
Last Name:LOKHORST
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 BLAZING STAR BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2866
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1476 BLAZING STAR BLVD STE 2
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2866
Practice Address - Country:US
Practice Address - Phone:651-645-5323
Practice Address - Fax:844-358-8786
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI11179-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program