MEDICARE: CAITLYN CORNELL LMSW

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	1041C0700X	Clinical Social Worker	2024017854	MO

General Provider Information

NPI Number	:	1538901608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLYN CORNELL LMSW

Provider Business Mailing Address
First Line	:	224 W MAPLE AVE
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64050-2816
Country	:	US
Telephone Number	:	816-381-7690
Fax Number	:	816-381-7652

Provider Business Practice Location Address
First Line	:	5155 RAYTOWN RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-2141
Country	:	US
Telephone Number	:	816-648-6830
Fax Number	:	816-648-6880

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

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/10/2024

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Directions to “ CAITLYN CORNELL LMSW” Practice Location

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