Provider Demographics
NPI:1700076056
Name:CORRIGAN, JESSICA RENEE BROKERING (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE BROKERING
Last Name:CORRIGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1208
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81402-1208
Mailing Address - Country:US
Mailing Address - Phone:970-240-6438
Mailing Address - Fax:970-240-9296
Practice Address - Street 1:528 N UNCOMPAHGRE AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3127
Practice Address - Country:US
Practice Address - Phone:970-240-6438
Practice Address - Fax:970-240-9296
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17131041C0700X
IN34006027A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical