Provider Demographics
NPI:1386431013
Name:THIBODEAU, ELIZABETH (DTR, ACE-CHC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:DTR, ACE-CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 OLD DIVIDE RD
Mailing Address - Street 2:
Mailing Address - City:ROUNDUP
Mailing Address - State:MT
Mailing Address - Zip Code:59072-6829
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:236 OLD DIVIDE RD
Practice Address - Street 2:
Practice Address - City:ROUNDUP
Practice Address - State:MT
Practice Address - Zip Code:59072-6829
Practice Address - Country:US
Practice Address - Phone:907-240-3267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered
No171400000XOther Service ProvidersHealth & Wellness Coach