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General NPI Number Information
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NPI Number | 1922176551
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Entity Type | Individual
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Provider Name | KIM ANN CORNISH PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 8788 ELK GROVE BLVD. BLDG. 2, STE F
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City | ELK GROVE
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State | CA
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Zip | 95624
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Country | US
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Telephone | 530-514-1066
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Fax | 916-687-3140
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Provider Business Mailing Address
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Address Line | 8698 ELK GROVE BLVD., SUITE 1, PMB 170
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City | ELK GROVE
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State | CA
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Zip | 95624
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Country | US
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Telephone | 530-514-1066
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Fax | 916-687-3140
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY18648
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License Number State | CA
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