Provider Demographics
NPI:1912375767
Name:CHERRY, KORI (LCSW)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:
Last Name:CHERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KORI
Other - Middle Name:
Other - Last Name:BOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1500 W ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-1710
Mailing Address - Country:US
Mailing Address - Phone:417-448-5624
Mailing Address - Fax:417-448-5606
Practice Address - Street 1:1500 W ASHLAND ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-1710
Practice Address - Country:US
Practice Address - Phone:417-448-5624
Practice Address - Fax:417-448-5606
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015020197104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker