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General NPI Number Information
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NPI Number | 1346994910
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Entity Type | Individual
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Provider Name | GABRIELLE OVERSTREET LAC
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Gender | Female
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Dates
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Enumeration Date | 02/11/2022
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 6851 167TH ST
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City | TINLEY PARK
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State | IL
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Zip | 60477-2501
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Country | US
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Telephone | 815-258-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 7748 W GARLAND CT
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City | FRANKFORT
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State | IL
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Zip | 60423-6964
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Country | US
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Telephone | 815-258-6700
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198001593
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License Number State | IL
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