Provider Demographics
NPI:1689192163
Name:GORMAN, JEANNIE MARIE (MS, CCN, LDN)
Entity Type:Individual
Prefix:MS
First Name:JEANNIE
Middle Name:MARIE
Last Name:GORMAN
Suffix:
Gender:F
Credentials:MS, CCN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1620
Mailing Address - Country:US
Mailing Address - Phone:630-414-9896
Mailing Address - Fax:
Practice Address - Street 1:310 W. BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559
Practice Address - Country:US
Practice Address - Phone:630-414-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education