MARK D ELLSWORTH Athletic Trainer License verification

Business Entity

INACTIVE

License Type

Athletic Trainer

Description

LICENSED ATHLETIC TRAINER

License Number

096000939

License Status

INACTIVE

Business

First Name

MARK D

Last Name

ELLSWORTH

Business Name

MARK D ELLSWORTH

Original Issue Date

11/19/1996

Effective Date

06/09/2000

Expiration Date

05/31/2000

City

LIBERTYVILLE

State

Zip

60048

County

LAKE

Ever Disciplined

LastModifiedDate

09/11/2005