Provider Demographics
NPI:1700834017
Name:CORRIGAN, JILL (LISW-CP)
Entity Type:Individual
Prefix:MISS
First Name:JILL
Middle Name:
Last Name:CORRIGAN
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MAID LYNN CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2900
Mailing Address - Country:US
Mailing Address - Phone:803-422-3265
Mailing Address - Fax:
Practice Address - Street 1:22 MAID LYNN CT
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2900
Practice Address - Country:US
Practice Address - Phone:803-422-3265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC62901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ342699190Medicare PIN