Provider Demographics
NPI:1215463674
Name:MCCLUSKY, CORIE
Entity type:Individual
Prefix:
First Name:CORIE
Middle Name:
Last Name:MCCLUSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORIE
Other - Middle Name:BETH
Other - Last Name:STAPLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:118 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-8911
Mailing Address - Country:US
Mailing Address - Phone:270-842-5268
Mailing Address - Fax:270-842-5268
Practice Address - Street 1:118 W UNION ST
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-8911
Practice Address - Country:US
Practice Address - Phone:270-842-5268
Practice Address - Fax:270-842-5268
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker