Provider Demographics
NPI:1093305229
Name:SORENSEN, HEATHER MARIE (BA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:SORENSEN
Suffix:
Gender:
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11918 51ST AVE NE APT A
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-8516
Mailing Address - Country:US
Mailing Address - Phone:360-743-0737
Mailing Address - Fax:
Practice Address - Street 1:1043 94TH DR NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-7813
Practice Address - Country:US
Practice Address - Phone:608-469-9904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61140768101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor