Provider Demographics
NPI:1316644172
Name:GUTERMUTH, CLOVER EMMALINE (LM, IBCLC)
Entity type:Individual
Prefix:
First Name:CLOVER
Middle Name:EMMALINE
Last Name:GUTERMUTH
Suffix:
Gender:F
Credentials:LM, IBCLC
Other - Prefix:
Other - First Name:CLOVER
Other - Middle Name:EMMALINE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5405 RED HILL RD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-9480
Mailing Address - Country:US
Mailing Address - Phone:510-590-8289
Mailing Address - Fax:
Practice Address - Street 1:5405 RED HILL RD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-9480
Practice Address - Country:US
Practice Address - Phone:510-590-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2025-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPM23020168176B00000X
CA703176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife