Provider Demographics
NPI:1245498807
Name:SORENSEN, CATHERINE ANN SR
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:ANN
Last Name:SORENSEN
Suffix:SR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ANN
Other - Last Name:BLAZER (HEATHERMAN)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56619-0640
Mailing Address - Country:US
Mailing Address - Phone:218-751-3298
Mailing Address - Fax:
Practice Address - Street 1:722 15TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-2528
Practice Address - Country:US
Practice Address - Phone:218-751-3280
Practice Address - Fax:218-751-3298
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN057441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical