Healthcare Provider Details

I. General information

NPI: 1538901608
Provider Name (Legal Business Name): CAITLYN CORNELL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 S HOCKER DR BLDG 12
INDEPENDENCE MO
64055-4754
US

IV. Provider business mailing address

224 W MAPLE AVE
INDEPENDENCE MO
64050-2816
US

V. Phone/Fax

Practice location:
  • Phone: 816-381-7690
  • Fax: 816-381-4356
Mailing address:
  • Phone: 816-381-7690
  • Fax: 816-381-7652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024017854
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: