Individual
JENNAN M GATEWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5831 GEIGER RD, ALHAMBRA, IL 62001-2227
(618) 978-4427
Mailing address
7034 CONNER POINTE DR, FAIRVIEW HEIGHTS, IL 62208-2093
(618) 978-4427
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
06/22/2016
Last updated
06/15/2023
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