NPI 1073339149

Gabrielle Tynisha Jackson

Practitioner Health & Wellness Coach Chicago, IL

Practice location

Address: 2706 N Halsted St STE B, Chicago, IL 60614-1414
Phone: (708) 808-6592
Mailing address: 7324 S Laflin St # 1s, Chicago, IL 60636-4020

Registered specialties

Health & Wellness Coach Primary

Other Service Providers Taxonomy 171400000X Licence 13109123 (IL)

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Registry record

NPI: 1073339149
Entity type: Individual
Sex (as registered): Female
NPI issued: 23 Nov 2024
Record last updated: 23 Nov 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.