Individual
RICHARD DERRICK SORENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.S.W.
Contact information
Practice address
899 W 1150 S, PROVO, UT 84601-5421
(801) 836-9504
Mailing address
899 W 1150 S, PROVO, UT 84601-5421
(801) 836-9504
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
295219-3501
UT
Other
Enumeration date
08/31/2012
Last updated
08/31/2012
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