Provider Demographics
NPI:1447835012
Name:DUTTLINGER, ARDELLE CARLENE (LMT)
Entity type:Individual
Prefix:
First Name:ARDELLE
Middle Name:CARLENE
Last Name:DUTTLINGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 BRATTON AVE
Mailing Address - Street 2:
Mailing Address - City:MARSEILLES
Mailing Address - State:IL
Mailing Address - Zip Code:61341-1006
Mailing Address - Country:US
Mailing Address - Phone:309-883-4363
Mailing Address - Fax:
Practice Address - Street 1:260 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:IL
Practice Address - Zip Code:61360-9414
Practice Address - Country:US
Practice Address - Phone:815-357-6858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227021458225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist