Provider Demographics
NPI:1235312620
Name:CORRIGAN, JENNIFER (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CORRIGAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1539
Mailing Address - Country:US
Mailing Address - Phone:989-672-6160
Mailing Address - Fax:989-672-5649
Practice Address - Street 1:624 W NEPESSING ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2090
Practice Address - Country:US
Practice Address - Phone:810-667-4500
Practice Address - Fax:810-667-4512
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801086364104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7509109650OtherBCBS
MI0G96288089Medicare PIN
MI0G96288Medicare UPIN