Provider Demographics
NPI:1780109405
Name:HARTIGAN, JESSICA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:HARTIGAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:134 CEDARBROOK LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-1841
Mailing Address - Country:US
Mailing Address - Phone:609-618-2945
Mailing Address - Fax:
Practice Address - Street 1:1064 S MAIN ST BLDG 2C
Practice Address - Street 2:
Practice Address - City:WEST CREEK
Practice Address - State:NJ
Practice Address - Zip Code:08092-2914
Practice Address - Country:US
Practice Address - Phone:609-488-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00913800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YS00913800Medicaid