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General NPI Number Information
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NPI Number | 1174479612
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Entity Type | Organization
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Legal Business Name | WHOLE WOMAN FITNESS LLC
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Dates
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Enumeration Date | 03/06/2026
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 2223 WASHINGTON ST
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City | EVANSTON
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State | IL
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Zip | 60202-1557
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Country | US
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Telephone | 773-242-7558
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Fax |
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Provider Business Mailing Address
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Address Line | 1716 EMERSON ST
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City | EVANSTON
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State | IL
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Zip | 60201-3438
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Country | US
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Telephone | 773-416-0899
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NETICIA WALDRON
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Credential | CPT, BSHA, MINISTER
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Telephone | 773-416-0899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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