Provider Demographics
NPI:1922826213
Name:CORNELIUS, ELENA
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:CORNELIUS
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-0727
Mailing Address - Country:US
Mailing Address - Phone:618-521-5416
Mailing Address - Fax:
Practice Address - Street 1:861 SW MADISON AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4512
Practice Address - Country:US
Practice Address - Phone:541-974-8873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical