Active NPI
360 Wellness
- Professional Counselor
- Shorewood, IL
National Provider Identifier
1629604277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Legal business name
- 360 WELLNESS
- Practice address
- 700 W Jefferson St Ste 2
Shorewood, IL 60404-7603 - Phone
- (815) 530-4397
- NPI assigned
- Mar 16, 2020
- Organization subpart
- Yes
- Parent organization
- ELITE FITNESS TRAINING STUDIO, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Dawn Siesener
- Title
- Owner/Personal Trainer
- Phone
- (815) 530-4397
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | Primary |
Addresses
Primary practice location
700 W Jefferson St Ste 2
Shorewood, IL 60404-7603
Mailing address
700 W Jefferson St Ste 2
Shorewood, IL 60404-7603
Phone (815) 530-4397
Other names 1
- 360 Wellness
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | N/A | Other |
National Provider Directory
National Provider Directory- Part of
- 360 Wellness
Locations
700 W Jefferson St
Ste 2
Shorewood, IL 60404
Phone (815) 530-4397
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584316800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1673740800000",
"number": "1629604277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 W JEFFERSON ST STE 2",
"city": "SHOREWOOD",
"state": "IL",
"postal_code": "604047603",
"telephone_number": "815-530-4397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 W JEFFERSON ST STE 2",
"city": "SHOREWOOD",
"state": "IL",
"postal_code": "604047603",
"telephone_number": "815-530-4397"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "360 WELLNESS",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ELITE FITNESS TRAINING STUDIO, INC.",
"enumeration_date": "2020-03-16",
"last_updated": "2023-01-15",
"certification_date": "2023-01-15",
"status": "A",
"authorized_official_last_name": "SIESENER",
"authorized_official_first_name": "DAWN",
"authorized_official_title_or_position": "OWNER/PERSONAL TRAINER",
"authorized_official_telephone_number": "815-530-4397",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "N/A",
"affiliation": "N",
"endpointDescription": "N/A",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "N/A",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "N/A",
"address_1": "700 W Jefferson St Ste 2",
"city": "Shorewood",
"state": "IL",
"country_code": "US",
"postal_code": "604047603",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "360 Wellness",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "360 Wellness",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Shorewood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.