Individual
MRS. MALLORY JEAN HENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6800 STATE ROUTE 162 STE 200, MARYVILLE, IL 62062-8521
(618) 288-0900
(618) 288-0909
Mailing address
12855 N 40 DR STE 375, SAINT LOUIS, MO 63141-8657
(314) 567-6071
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085007315
IL
Other
Enumeration date
11/18/2019
Last updated
08/15/2023
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