Gardens At Roundtable | |
904 South St Lafayette IN 47901-1416 | |
(765) 630-7222 | |
(765) 807-3210 |
Full Name | Gardens At Roundtable |
---|---|
Speciality | Social Worker - Clinical |
Location | 904 South St, Lafayette, Indiana |
Authorized Official Name and Position | Renee Michelle Tilt (OWNER & REGISTERED DIETITIAN) |
Authorized Official Contact | 7656307222 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Gardens At Roundtable 904 South St Lafayette IN 47901-1416 Ph: (765) 630-7222 | Gardens At Roundtable 904 South St Lafayette IN 47901-1416 Ph: (765) 630-7222 |
NPI Number | 1053853168 |
---|---|
Provider Enumeration Date | 11/07/2016 |
Last Update Date | 11/08/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053853168 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
133V00000X | Dietitian, Registered | (* (Not Available)) | Secondary |
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