Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mariellen Mardis, MAT

Individual provider Athletic Trainer · NPI 1700450665

Mariellen Mardis, MAT is an Athletic Trainer in Lake Bluff, Illinois. Licensed in Illinois. Registered with an NPI since 2021.

Licensed in
IL
In the registry since
2021
Specialties on file
2

Practice location Address checks out

30019 N Waukegan Rd Apt 103
Lake Bluff, IL 60044-1079
Phone: (618) 980-0482
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X · Licence 096.004744 (IL)
Athletic Trainer Taxonomy 2255A2300X

Record details

NPI number1700450665
Entity typeIndividual (Type 1)
GenderFemale
Credentials MAT
Sole proprietorNo
NPI enumeratedMay 16, 2021
Last updated in NPPESMay 16, 2021
Certification dateMay 16, 2021