Individual
BROOKLYN GUNDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1501 W BRADLEY AVE, PEORIA, IL 61625-3219
(715) 507-0439
Mailing address
5815 N ASPEN WOOD DR APT 5203, PEORIA, IL 61615-8429
(715) 507-0439
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.005574
IL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
01/13/2020
Last updated
02/21/2024
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