Provider Demographics
NPI:1457569113
Name:SORENSON, JUDITH B (MS,CCC,SLP)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:B
Last Name:SORENSON
Suffix:
Gender:F
Credentials:MS,CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25545 N ONEIDA LN
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-7007
Mailing Address - Country:US
Mailing Address - Phone:847-842-4257
Mailing Address - Fax:847-842-4465
Practice Address - Street 1:450 W IL ROUTE 22
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-7509
Practice Address - Country:US
Practice Address - Phone:847-842-4257
Practice Address - Fax:847-842-4465
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist