Individual
ELLIE MASENGALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
701 DEVONSHIRE DR, BLDG C SUITE 101B, CHAMPAIGN, IL 61820-7337
(217) 912-4461
Mailing address
701 DEVONSHIRE DR, CHAMPAIGN, IL 61820-7337
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150118099
IL
Other
Enumeration date
09/20/2025
Last updated
09/20/2025
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