Individual
DR. TASHANNA GILLENWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED.D
Contact information
Practice address
3818 216TH PL, MATTESON, IL 60443-2725
(773) 269-0301
(708) 964-2178
Mailing address
3818 216TH PL, MATTESON, IL 60443-2725
(773) 269-0301
(708) 964-2178
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
3020440
IL
171400000X
Health & Wellness Coach
340416
IL
171400000X
Health & Wellness Coach
—
IL
174H00000X
Health Educator
Primary
340416
IL
Other
Enumeration date
04/17/2023
Last updated
05/05/2023
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