Provider Demographics
NPI:1962788570
Name:KORDELL, ANNALISE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ANNALISE
Middle Name:
Last Name:KORDELL
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 1:1065 E MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-4606
Mailing Address - Country:US
Mailing Address - Phone:626-240-9193
Mailing Address - Fax:
Practice Address - Street 1:1065 E MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-4606
Practice Address - Country:US
Practice Address - Phone:626-240-9193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 282681041C0700X
IL149.0128821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical