Individual
MARIELLEN MARDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MAT
Contact information
Practice address
30019 N WAUKEGAN RD APT 103, LAKE BLUFF, IL 60044-1079
(618) 980-0482
Mailing address
30019 N WAUKEGAN RD APT 103, LAKE BLUFF, IL 60044-1079
(618) 980-0482
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.004744
IL
2255A2300X
Athletic Trainer
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Other
Enumeration date
05/16/2021
Last updated
05/16/2021
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