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Individual
MARY ANN CORNELIUSSEN
Active
Individual
MARY ANN CORNELIUSSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801088231
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H21692
BLUE CROSS
MI
01
—
1093940272
GROUP NPI HENRY FORD WYANDOTTE
MI
Enumeration date
07/19/2013
Last updated
02/21/2017
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