| 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 | (NU) | Primary |
| 133V00000X | Dietitian, Registered | (NU) | Secondary |
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