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General NPI Number Information
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NPI Number | 1053201673
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Entity Type | Individual
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Provider Name | JENNIFER N MCGOWEN LMBT
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Gender | Female
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 650 N DEARBORN ST STE 800
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City | CHICAGO
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State | IL
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Zip | 60654-3874
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Country | US
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Telephone | 910-271-0117
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Fax |
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Provider Business Mailing Address
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Address Line | 1659 S CALIFORNIA AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60608-2165
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227024275
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License Number State | IL
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