MEDICARE: JENNIE L CORNELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker	3118	SD
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	1945	ND
4	1041C0700X	Clinical Social Worker	3840	ND

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00898858	OTHER	SD	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1437380763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIE L CORNELL

Provider Business Mailing Address
First Line	:	1716 9TH AVE SE
Second Line	:
City	:	MANDAN
State	:	ND
Zip	:	58554-4819
Country	:	US
Telephone Number	:	218-790-3636
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 S 12TH ST STE 101
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-5941
Country	:	US
Telephone Number	:	701-255-4242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	03/13/2024

Similar Medicare Providers

1215640180 — COAL COUNTRY COMMUNITY HEALTH CENTER
Practice Location Address:

914 S 12TH ST STE 101A
BISMARCK, ND
58504-5941

Practice Phone: 701-873-4445
Practice Fax:

1962712778 — MICHELLE ANN MCCAMY SW
Practice Location Address:

914 S 12TH ST STE 101
BISMARCK, ND
58504-5941

Practice Phone: 701-554-2442
Practice Fax: 701-258-5999

1649717851 — BREANN MARIE RAYMOND
Practice Location Address:

914 S 12TH ST STE 101
BISMARCK, ND
58504-5941

Practice Phone: 701-255-4242
Practice Fax:

1871164236 — BROOKE M THOM DNP, FNP-C
Practice Location Address:

914 S 12TH ST STE 101
BISMARCK, ND
58504-5941

Practice Phone: 701-255-4242
Practice Fax:

1811707730 — PRISCILLA DUNHAM PMHNP
Practice Location Address:

914 S 12TH ST STE 101
BISMARCK, ND
58504-5941

Practice Phone: 701-255-4242
Practice Fax:

1841983186 — DANIKA BURKETT LPCC
Practice Location Address:

600 S 2ND ST STE 220
BISMARCK, ND
58504-5729

Practice Phone: 701-224-9611
Practice Fax:

Directions to “ JENNIE L CORNELL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.