Tashanna Gillenwater, ED.D

Primary specialty

Health EducatorTaxonomy code 174H00000X

License

340416 Issued in IL

Practice address

3818 216TH PL
Matteson, IL 60443-2725

Phone

(773) 269-0301

Fax

(708) 964-2178

NPI assigned

Apr 17, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Knowing You Health & Wellness

  • Point of Service
  • Matteson, IL
  • NPI 1306646229
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683244800000",
    "number": "1831885292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3818 216TH PL",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604432725",
            "telephone_number": "773-269-0301",
            "fax_number": "708-964-2178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3818 216TH PL",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604432725",
            "telephone_number": "773-269-0301",
            "fax_number": "708-964-2178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLENWATER",
        "first_name": "TASHANNA",
        "name_prefix": "Dr.",
        "credential": "ED.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-17",
        "last_updated": "2023-05-05",
        "certification_date": "2023-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "IL",
            "license": "3020440",
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "IL",
            "license": "340416",
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "IL",
            "license": "340416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health Educator in Matteson, IL
• Providers in Matteson, IL by specialty
• Health Educator in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 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.

Verify at the official NPI Registry.