MEDICARE: JENNIFER CORRIGAN LMSW

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	104100000X	Social Worker	6801086364	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7509109650	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1235312620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CORRIGAN LMSW

Provider Business Mailing Address
First Line	:	443 N STATE ST
Second Line	:
City	:	CARO
State	:	MI
Zip	:	48723-1539
Country	:	US
Telephone Number	:	989-672-6160
Fax Number	:	989-672-5649

Provider Business Practice Location Address
First Line	:	624 W NEPESSING ST
Second Line	:	SUITE 300
City	:	LAPEER
State	:	MI
Zip	:	48446-2090
Country	:	US
Telephone Number	:	810-667-4500
Fax Number	:	810-667-4512

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

Provider Enumeration Date	:	12/10/2007
Last Update Date	:	06/15/2012

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