Healthcare Provider Details

I. General information

NPI: 1063614121
Provider Name (Legal Business Name): GA CONSULTING AND MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E ONTARIO ST APT 808
CHICAGO IL
60611-3051
US

IV. Provider business mailing address

401 E ONTARIO ST APT 808
CHICAGO IL
60611-3051
US

V. Phone/Fax

Practice location:
  • Phone: 847-490-4603
  • Fax:
Mailing address:
  • Phone: 847-490-4603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateIL

VIII. Authorized Official

Name: ANDREA JILL GOYNSHOR
Title or Position: REGISTERED DIETITIAN
Credential: MPH,RD,LDN,CDE
Phone: 847-490-4603