Elizabeth Thibodeau, DTR, ACE-CHC

Individual provider Active NPI Registered Dietetic Technician · Roundup, MT

NPI 1386431013 · NPPES record last updated Apr 24, 2025

Key facts

NPI
1386431013
Entity type
Individual (NPI type 1)
Primary specialty
Registered Dietetic Technician 136A00000X
Practice address
236 Old Divide Rd
Roundup, MT 59072-6829
Phone
(907) 240-3267
NPI assigned
Apr 24, 2025
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Cranberry Blossom Nutrition & Wellness, LLC Current
since Apr 27, 2025
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Health & Wellness Coach 171400000X
Registered Dietetic Technician 136A00000X Yes

Addresses

Primary practice location

236 Old Divide Rd
Roundup, MT 59072-6829

Mailing address

236 Old Divide Rd
Roundup, MT 59072-6829

Other providers in Roundup, MT

All providers in Roundup, MT · Registered Dietetic Technician in Montana

Sources for this page

Verify at the official NPI Registry.