Organization
GARDENS AT ROUNDTABLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE MICHELLE TILT RDN, CSP (OWNER & REGISTERED DIETITIAN)
(765) 630-7222
Entity
Organization
Contact information
Practice address
904 SOUTH ST, LAFAYETTE, IN 47901-1416
(765) 630-7222
(765) 807-3210
Mailing address
904 SOUTH ST, LAFAYETTE, IN 47901-1416
(765) 630-7222
(765) 807-3210
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
133V00000X
Registered Dietitian
—
—
Other
Enumeration date
11/07/2016
Last updated
11/08/2016
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