Healthcare Provider Details

I. General information

NPI: 1154239895
Provider Name (Legal Business Name): JESSICA POWELL CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 CRESCENT BLVD STE 210
GLEN ELLYN IL
60137-4177
US

IV. Provider business mailing address

287 OAK ST
GLEN ELLYN IL
60137-3813
US

V. Phone/Fax

Practice location:
  • Phone: 630-566-4632
  • Fax:
Mailing address:
  • Phone: 312-573-0192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number164.024645
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: