Individual
JENNIE L CORNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
914 S 12TH ST STE 101, BISMARCK, ND 58504-5941
(701) 255-4242
Mailing address
1716 9TH AVE SE, MANDAN, ND 58554-4819
(218) 790-3636
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1945
ND
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
3118
SD
1041C0700X
Clinical Social Worker
Primary
3840
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00898858
RAILROAD MEDICARE
SD
Enumeration date
08/04/2009
Last updated
03/13/2024
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