Provider Demographics
NPI:1760916464
Name:SORENSEN, JOLENE ESTELL
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:ESTELL
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOLENE
Other - Middle Name:ESTELL
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:448 MILLER ST S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4221
Mailing Address - Country:US
Mailing Address - Phone:971-600-5582
Mailing Address - Fax:
Practice Address - Street 1:448 MILLER ST S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4221
Practice Address - Country:US
Practice Address - Phone:971-600-5582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator