Provider Demographics
NPI:1871069138
Name:SORENSEN, KAITLYN L (AUD)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:L
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6659 WHITESTOWN PKWY
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-7622
Mailing Address - Country:US
Mailing Address - Phone:317-973-7109
Mailing Address - Fax:
Practice Address - Street 1:55 S RACEWAY RD STE 900
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46231-1064
Practice Address - Country:US
Practice Address - Phone:317-973-7109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002666A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist