Healthcare Provider Details

I. General information

NPI: 1386346245
Provider Name (Legal Business Name): ASHLEE MACKENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W WASHINGTON ST STE 1500
CHICAGO IL
60606-3485
US

IV. Provider business mailing address

8414 NAAB RD
INDIANAPOLIS IN
46260-1972
US

V. Phone/Fax

Practice location:
  • Phone: 847-504-5000
  • Fax:
Mailing address:
  • Phone: 317-338-7510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD-001165
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: