Provider Demographics
NPI:1760362446
Name:HAGGERTY, JAYLYNN LORRAINE
Entity type:Individual
Prefix:
First Name:JAYLYNN
Middle Name:LORRAINE
Last Name:HAGGERTY
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 1:223 WALNUT ST W APT 13
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-4304
Mailing Address - Country:US
Mailing Address - Phone:701-350-2917
Mailing Address - Fax:
Practice Address - Street 1:223 WALNUT ST W APT 13
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-4304
Practice Address - Country:US
Practice Address - Phone:701-350-2917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care