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General NPI Number Information
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NPI Number | 1619572419
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Entity Type | Organization
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Legal Business Name | PROSPER HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 7901 W 159TH ST
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City | TINLEY PARK
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State | IL
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Zip | 60477-1881
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Country | US
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Telephone | 312-279-9814
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Fax | 312-279-9879
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Provider Business Mailing Address
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Address Line | 122 S MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60603-6191
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Country | US
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Telephone | 312-279-9814
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Fax | 312-279-9879
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Authorized Official
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Title or Position | CEO
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Name | GLADYS LARSEN
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Credential | NP
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Telephone | 708-465-2299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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