Provider Demographics
NPI:1407468523
Name:FLANIGAN, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FLANIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 HOMESTEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3425
Mailing Address - Country:US
Mailing Address - Phone:530-559-8338
Mailing Address - Fax:
Practice Address - Street 1:29 HOMESTEAD BLVD
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3425
Practice Address - Country:US
Practice Address - Phone:530-559-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No174H00000XOther Service ProvidersHealth Educator