Seth Sorum

Key facts

NPI

1134762016

Entity type

Individual (NPI type 1)

Primary specialty

Behavior Analyst 103K00000X

License

LBA0084 (MN)

Practice address

5155 Miller Trunk Hwy
Hermantown, MN 55811-1203

Phone

(612) 488-9043

NPI assigned

Oct 23, 2019

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 14, 2025.

{
    "created_epoch": "1571788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763078400000",
    "number": "1134762016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5860 BAKER RD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553455903",
            "telephone_number": "612-488-9043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5155 MILLER TRUNK HWY",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558111203",
            "telephone_number": "612-488-9043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SORUM",
        "first_name": "SETH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-23",
        "last_updated": "2025-11-14",
        "certification_date": "2025-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MN",
            "license": "LBA0084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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