# GLOW HEALTH AND WELLNESS MEDICAL SPA, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205345337
- **Authorized official:** MS. TAJUANA D. JOHNSON FNP (OWNER, MANAGER)
- **Authorized official phone:** (630) 901-2879

## Contact information

- **Practice address:** 1528 W MONROE ST STE 100, CHICAGO, IL 60607-2460
- **Practice address phone:** (630) 901-2879
- **Mailing address:** 1001 W 15TH ST UNIT 320, CHICAGO, IL 60608-2778

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 209008594 | IL | Yes |
| 261QI0500X | Infusion Therapy Clinic/Center | 209008594 | IL | — |

## Other

- **Enumeration date:** 09/20/2017
- **Last updated:** 09/20/2017