Provider Demographics
NPI:1528601804
Name:THIBODEAU, TAHNEE MICHEL (RD, CNSC)
Entity Type:Individual
Prefix:MS
First Name:TAHNEE
Middle Name:MICHEL
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:RD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 TOWN TRL
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-8023
Mailing Address - Country:US
Mailing Address - Phone:517-304-4445
Mailing Address - Fax:
Practice Address - Street 1:1025 TOWN TRL
Practice Address - Street 2:
Practice Address - City:PINCKNEY
Practice Address - State:MI
Practice Address - Zip Code:48169-8023
Practice Address - Country:US
Practice Address - Phone:517-304-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-19
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI801329133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered