Provider Demographics
NPI:1063931251
Name:CORNHILL, JEFFERY L (LSW)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:L
Last Name:CORNHILL
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5267
Mailing Address - Country:US
Mailing Address - Phone:419-330-1060
Mailing Address - Fax:
Practice Address - Street 1:109 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ALVORDTON
Practice Address - State:OH
Practice Address - Zip Code:43501-9763
Practice Address - Country:US
Practice Address - Phone:419-954-2029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INS.00231741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical