Individual
KIMBERLY GROTELUESCHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
555 W FAIRBORN LN, ROUND LAKE, IL 60073-5602
(224) 308-6555
Mailing address
555 W FAIRBORN LN, ROUND LAKE, IL 60073-5602
(224) 308-6555
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
G63451095961
IL
390200000X
Student in an Organized Health Care Education/Training Program
G63451095961
IL
Other
Enumeration date
08/08/2016
Last updated
08/08/2016
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