Individual
MICAH LYNN ANN CLUTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
324 ROXBURY RD, ROCKFORD, IL 61107-5090
(815) 398-9491
(815) 381-7498
Mailing address
BOX 78534, MILWAUKEE, WI 53278-8534
(815) 398-9491
(815) 381-7498
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
085-007766
IL
Other
Enumeration date
03/25/2020
Last updated
07/30/2020
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