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General NPI Number Information
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NPI Number | 1558153676
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Entity Type | Individual
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Provider Name | LORI E KORNACK
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Gender | Female
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 2513 24TH ST
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City | ROCK ISLAND
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State | IL
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Zip | 61201-5305
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Country | US
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Telephone | 563-265-1454
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Fax |
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Provider Business Mailing Address
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Address Line | 2131 HIGHLAND AVE
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City | DAVENPORT
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State | IA
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Zip | 52803-2035
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Country | US
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Telephone | 630-774-6847
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180017160
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License Number State | IL
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