Provider Demographics
NPI:1407642259
Name:CORNELL, LANDON
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:
Last Name:CORNELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 W PURDUE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-1905
Mailing Address - Country:US
Mailing Address - Phone:303-912-7755
Mailing Address - Fax:
Practice Address - Street 1:7910 W PURDUE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-1905
Practice Address - Country:US
Practice Address - Phone:303-912-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician