Provider Demographics
NPI:1356007033
Name:CORRINGTON, JESSICA LADAWN (LMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LADAWN
Last Name:CORRINGTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LADAWN
Other - Last Name:SARTORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1241 E FOURTH AVE
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-9644
Mailing Address - Country:US
Mailing Address - Phone:623-986-9527
Mailing Address - Fax:
Practice Address - Street 1:1241 E FOURTH AVE
Practice Address - Street 2:
Practice Address - City:SUTHERLIN
Practice Address - State:OR
Practice Address - Zip Code:97479-9644
Practice Address - Country:US
Practice Address - Phone:623-986-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26054225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist