Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1259 | OR |
Y | 103TC0700X | Clinical Psychologist | 1259 | OR |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 1259 | OR |
NPI | 1013071331 |
---|---|
Provider Name | Erik D Sorensen |
First Address | Eugene, OR 97401-3608 |
Second Address | Eugene, OR 97401-3608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 11/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S88637 | (02) | OR |