Provider Demographics
NPI:1043967920
Name:JESSI HAGGERTY LLC
Entity type:Organization
Organization Name:JESSI HAGGERTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:516-410-3723
Mailing Address - Street 1:55 PERKINS ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5538
Mailing Address - Country:US
Mailing Address - Phone:516-410-3723
Mailing Address - Fax:617-207-4357
Practice Address - Street 1:55 PERKINS ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5538
Practice Address - Country:US
Practice Address - Phone:516-410-3723
Practice Address - Fax:617-207-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty