Provider Demographics
NPI:1487066221
Name:SORENSON, REBECCA (MSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SORENSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 B CLEMSON DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122
Mailing Address - Country:US
Mailing Address - Phone:651-491-0714
Mailing Address - Fax:651-328-8254
Practice Address - Street 1:4590 SCOTT TRAIL
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122
Practice Address - Country:US
Practice Address - Phone:651-491-0714
Practice Address - Fax:651-328-8254
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN198821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical