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NPI Code Detail

MEDICARE: CLOVER SOLUTIONS LLC

MEDICARE: CLOVER SOLUTIONS LLC
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1144814773
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLOVER SOLUTIONS LLC
Provider Business Mailing Address
First Line : 5221 6TH STREET FRONTAGE RD E
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-5190
Country : US
Telephone Number : 217-292-1983
Fax Number :
Provider Business Practice Location Address
First Line : 5221 6TH STREET FRONTAGE RD E
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-5190
Country : US
Telephone Number : 217-292-1983
Fax Number :
Authorized Official
Title or Position : OWNER/PRACTICE MANAGER
Name : KELLY TRUTTER
Credential : PHD
Telephone Number : 217-292-1983
Provider Enumeration Date : 02/24/2021
Last Update Date : 02/24/2021

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Directions to “CLOVER SOLUTIONS LLC ” Practice Location

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