MEDICARE: JO HALLIGAN CERTPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1619135472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO HALLIGAN CERTPS

Provider Business Mailing Address
First Line	:	1545 W MOCKINGBIRD LN
Second Line	:	SUITE 3005
City	:	DALLAS
State	:	TX
Zip	:	75235-5014
Country	:	US
Telephone Number	:	214-819-9911
Fax Number	:	214-819-9944

Provider Business Practice Location Address
First Line	:	1545 W MOCKINGBIRD LN
Second Line	:	SUITE 3005
City	:	DALLAS
State	:	TX
Zip	:	75235-5014
Country	:	US
Telephone Number	:	214-819-9911
Fax Number	:	214-819-9944

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	05/29/2008

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Directions to “ JO HALLIGAN CERTPS” Practice Location

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