Individual
STACIE MICHELLE CORNWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSED
Contact information
Practice address
1306 MILITARY RD STE 1, BENTON, AR 72015-2732
(501) 481-8930
(501) 408-4699
Mailing address
2915 SAINT ANDREWS DR, BENTON, AR 72019-6874
(501) 481-8930
(501) 408-4699
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
05/15/2017
Last updated
05/15/2017
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