Individual
MRS. JESSICA ANN CORNWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
113 COMANCHE RD, FORT MEADE, SD 57741-1002
(218) 343-7584
Mailing address
113 COMANCHE RD, FORT MEADE, SD 57741-1002
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8627-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
460429218
BLACK HILLS HEALTH CARE CENTER
SD
Enumeration date
06/25/2021
Last updated
03/20/2024
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