Individual
GABRIELLE TYNISHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2706 N HALSTED ST STE B, CHICAGO, IL 60614-1414
(708) 808-6592
Mailing address
7324 S LAFLIN ST # 1S, CHICAGO, IL 60636-4020
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
Primary
13109123
IL
Other
Enumeration date
11/23/2024
Last updated
11/23/2024
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