Healthcare Provider Details

I. General information

NPI: 1528974409
Provider Name (Legal Business Name): JESSICA A CORRIGAN MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 MAPLE AVE
GLENSIDE PA
19038-2722
US

IV. Provider business mailing address

1051 MAPLE AVE
GLENSIDE PA
19038-2722
US

V. Phone/Fax

Practice location:
  • Phone: 215-272-0587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN006689
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: