Provider Demographics
NPI:1932639333
Name:HAGGERTY, JESSICA (RDN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 ELM ST STE 300B
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2950
Mailing Address - Country:US
Mailing Address - Phone:516-410-3723
Mailing Address - Fax:
Practice Address - Street 1:259 ELM ST STE 300B
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2950
Practice Address - Country:US
Practice Address - Phone:516-410-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4317133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered