Provider Demographics
NPI:1972274827
Name:CORNETT, HEATHER LYNN (LLMSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:CORNETT
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 KALCHIK RD
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8538
Mailing Address - Country:US
Mailing Address - Phone:231-622-3552
Mailing Address - Fax:
Practice Address - Street 1:231 STATE ST STE 7
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2785
Practice Address - Country:US
Practice Address - Phone:231-622-3552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511109011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty