Provider Demographics
NPI:1548381403
Name:ROOD, TARA SUZANNE (RD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:SUZANNE
Last Name:ROOD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:10053 BOULDER PASS
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-2054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4986 N ADAMS RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-1416
Practice Address - Country:US
Practice Address - Phone:248-475-4880
Practice Address - Fax:248-475-4881
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI973454133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered