Provider Demographics
NPI:1932832854
Name:KELSEY SORENSEN LLC
Entity Type:Organization
Organization Name:KELSEY SORENSEN LLC
Other - Org Name:NORTHERN OAK WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:612-444-2897
Mailing Address - Street 1:716 COUNTY ROAD 10 NE # 189
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-2331
Mailing Address - Country:US
Mailing Address - Phone:612-367-6040
Mailing Address - Fax:
Practice Address - Street 1:9315 EVERGREEN BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433
Practice Address - Country:US
Practice Address - Phone:612-444-2987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty