Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003203548 |
---|---|
Provider Name | Jill Sorensen |
First Address | Murray, UT 84121-1720 |
Second Address | Murray, UT 84121-1720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2015 |
Last Update Date | 22/04/2015 |