| Doctor Name: | DR. KELLY AKIKO CORNETT |
| NPI Number: | 1356789457 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | |
| Business Practice Address: | 3075 Orchard Vista Dr Se Grand Rapids, MI - 495467069 |
| Business Phone Number: | 8183095900 |
| Business Fax Number: | |
| Mailing Address: | 685 Parkside Ct Unit 103, OAK PARK |
| State: | CA |
| Postal Code: | 913775663 |
| Phone Number: | 8183095300 |
| Fax Number: | |
| NPI Enumeration Date: | 06/11/2013 |
| NPI Last Update Date: | 06/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103G00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Clinical Neuropsychologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |