Provider Demographics
NPI:1376340828
Name:GLUCK, AMY ALISON (RD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ALISON
Last Name:GLUCK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10415 SARAH JEAN DR
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-8886
Mailing Address - Country:US
Mailing Address - Phone:313-510-5164
Mailing Address - Fax:
Practice Address - Street 1:10415 SARAH JEAN DR
Practice Address - Street 2:
Practice Address - City:PINCKNEY
Practice Address - State:MI
Practice Address - Zip Code:48169-8886
Practice Address - Country:US
Practice Address - Phone:313-510-5164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI870161133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered