Individual
GWENN NONE MARIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCPP, BCTMB, LMT
Contact information
Practice address
2416 E WASHINGTON ST STE A9, BLOOMINGTON, IL 61704-1612
(309) 310-6472
Mailing address
13 BROADWAY PL, NORMAL, IL 61761-3620
(309) 310-6472
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227.001257
IL
Other
Enumeration date
04/30/2020
Last updated
04/30/2020
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