Provider Demographics
NPI:1720702095
Name:CORRIGAN, JESSICA LYNN (LAC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:CORRIGAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:BEACH LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:18405-9777
Mailing Address - Country:US
Mailing Address - Phone:570-903-5130
Mailing Address - Fax:
Practice Address - Street 1:12 VILLAGE RD
Practice Address - Street 2:
Practice Address - City:BEACH LAKE
Practice Address - State:PA
Practice Address - Zip Code:18405-9701
Practice Address - Country:US
Practice Address - Phone:570-352-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001385171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist