Provider Demographics
NPI:1225583768
Name:CORNELL, ALISON JANELL (LCSW)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:JANELL
Last Name:CORNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 BURNAM RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-1411
Mailing Address - Country:US
Mailing Address - Phone:816-646-4459
Mailing Address - Fax:
Practice Address - Street 1:1419 BURNAM RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-1411
Practice Address - Country:US
Practice Address - Phone:816-646-4459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180403671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490035143Medicaid