Sheila Jo Kornblum, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

LCSW 2224-C Issued in AR

Practice address

609 SW 8TH St
Suite 600
Bentonville, AR 72712-7886

Phone

(479) 418-1087

NPI assigned

Nov 9, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Sheila Jo Beckton Former name

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393372800000",
    "number": "1144400912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 SW 8TH ST",
            "address_2": "SUITE 600",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727127886",
            "telephone_number": "479-418-1087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 SW 8TH ST",
            "address_2": "SUITE 600",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727127886",
            "telephone_number": "479-418-1087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORNBLUM",
        "first_name": "SHEILA",
        "middle_name": "JO",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-09",
        "last_updated": "2014-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AR",
            "license": "LCSW 2224-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHEILA",
            "last_name": "BECKTON",
            "middle_name": "JO",
            "credential": "LCSW, LMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Taylor Matthew Knight
• Alison A. Knox, APRN
• Steven C Ko, PT
• Timothy Robert Koch, R.PH
• Scott Charles Koenig, MHPP
• Kos House Therapy, PLLC
• Candice Kozark, LAC
• Faith Kramer
• Kristian C. Dietz, DDS, PLLC
• Meredith R Krohn, APRN

• Social Worker in Bentonville, AR
• Providers in Bentonville, AR by specialty
• Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.