Provider Demographics
NPI:1265250641
Name:SORENSON, JILLIAN NONI (CF-SLP)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:NONI
Last Name:SORENSON
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 10TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-8625
Mailing Address - Country:US
Mailing Address - Phone:562-552-0129
Mailing Address - Fax:
Practice Address - Street 1:141 S KNOTT AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1458
Practice Address - Country:US
Practice Address - Phone:714-821-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19778235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist