Individual
MACKENZIE SHALLENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
640 W WASHINGTON ST, PITTSFIELD, IL 62363-1350
(217) 285-2113
(217) 277-3960
Mailing address
2650 WARRENVILLE RD, STE. 280, DOWNERS GROVE, IL 60515-1748
(630) 324-7900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-004155
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1101093
NCCPA
IL
Enumeration date
02/20/2012
Last updated
03/22/2023
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