Provider Demographics
NPI:1932954781
Name:GALLAGHER, JACKLYNN CHRISTY
Entity Type:Individual
Prefix:
First Name:JACKLYNN
Middle Name:CHRISTY
Last Name:GALLAGHER
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 1:922 BRANCH ST
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-1004
Mailing Address - Country:US
Mailing Address - Phone:616-432-1963
Mailing Address - Fax:
Practice Address - Street 1:630 JOHNSON ST APT 209
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-1385
Practice Address - Country:US
Practice Address - Phone:616-432-1963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty