Provider Demographics
NPI:1306026059
Name:CORCORAN, JESSICA COLLEEN (MSCCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:COLLEEN
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2646
Mailing Address - Country:US
Mailing Address - Phone:570-421-2232
Mailing Address - Fax:
Practice Address - Street 1:1219 N 5TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2646
Practice Address - Country:US
Practice Address - Phone:570-421-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-10
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist