| Kaitlyn Cornell | |
|
206 N Randolph St Ste 508 Champaign IL 61820-3949 | |
| (217) 377-0299 | |
| (855) 750-3291 |
| Full Name | Kaitlyn Cornell |
|---|---|
| Speciality | Social Worker |
| Location | 206 N Randolph St Ste 508, Champaign, Illinois |
| Authorized Official Name and Position | Kaitlyn Cornell (OWNER/PROVIDER) |
| Authorized Official Contact | 2173770299 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kaitlyn Cornell 1104 W Park Ave Champaign IL 61821-3245 Ph: (217) 621-0766 | Kaitlyn Cornell 206 N Randolph St Ste 508 Champaign IL 61820-3949 Ph: (217) 377-0299 |
| NPI Number | 1518425230 |
|---|---|
| Provider Enumeration Date | 03/12/2019 |
| Last Update Date | 01/27/2020 |
| Certification Date | 01/27/2020 |
| Medicare PECOS PAC ID | 4183061823 |
|---|---|
| Medicare Enrollment ID | O20240318002016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518425230 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kaitlyn R Cornell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992290449 PECOS PAC ID: 1850642778 Enrollment ID: I20180915000036 |
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