Provider Demographics
NPI:1831211234
Name:SORENSON, KATHARINE RHODES (KATHARINE SORENSON)
Entity type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:RHODES
Last Name:SORENSON
Suffix:
Gender:F
Credentials:KATHARINE SORENSON
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:
Other - Last Name:SORENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KATHARINE SORENSON
Mailing Address - Street 1:7075 GOLDEN OAKS LOOP W STE 11
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9012
Mailing Address - Country:US
Mailing Address - Phone:662-349-9920
Mailing Address - Fax:662-349-3988
Practice Address - Street 1:7075 GOLDEN OAKS LOOP W STE 11
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9012
Practice Address - Country:US
Practice Address - Phone:662-349-9920
Practice Address - Fax:662-349-3988
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA2794231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04405367Medicaid
MS04405367Medicaid
MSQ18734Medicare UPIN