MEDICARE: LAUREN CLUTTER MA, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	146009511	IL

General Provider Information

NPI Number	:	1063606812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN CLUTTER MA, CCC-SLP

Provider Business Mailing Address
First Line	:	4044 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3038
Country	:	US
Telephone Number	:	317-508-7565
Fax Number	:

Provider Business Practice Location Address
First Line	:	4044 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3038
Country	:	US
Telephone Number	:	317-508-7565
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	07/21/2022

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Directions to “ LAUREN CLUTTER MA, CCC-SLP” Practice Location

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