Healthcare Provider Details

I. General information

NPI: 1164064416
Provider Name (Legal Business Name): AUBREY CORNWALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8809B CINCINNATI DAYTON RD
WEST CHESTER OH
45069-3134
US

IV. Provider business mailing address

6552 MURRAY AVE APT 3
CINCINNATI OH
45227-3052
US

V. Phone/Fax

Practice location:
  • Phone: 330-323-5669
  • Fax:
Mailing address:
  • Phone: 330-323-5669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2204433
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberAPP-000411691
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberAPP-000411691
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: