Provider Information for 1093902033
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Ms. JENNIFER G LACORTIGLIA LISW S
Other Names:Former Name:Mrs. JENNIFER GL DUDICHSex: Female
NPI: 1093902033
Last Updated: 2021-10-13
Certification Date: 2021-10-13
Certification Date: 2021-10-13
Details
| Name | Value | ||||||||
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| NPI | 1093902033 | ||||||||
| Enumeration Date | 2007-10-03 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 11575 LOWER CHELSEA DR CHARDON, OH 44024-9308 United States Phone: 440-212-4278 | Fax: | ||||||||
| Primary Practice Address | 11575 LOWER CHELSEA DR CHARDON, OH 44024-9308 United States Phone: 440-212-4278 | Fax: | ||||||||
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