Provider Demographics
NPI:1780335794
Name:ROOTS NUTRITION COUNSELING INC.
Entity type:Organization
Organization Name:ROOTS NUTRITION COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:641-430-3076
Mailing Address - Street 1:211 N FEDERAL AVE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-3209
Mailing Address - Country:US
Mailing Address - Phone:641-450-0003
Mailing Address - Fax:641-450-0004
Practice Address - Street 1:211 N FEDERAL AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3209
Practice Address - Country:US
Practice Address - Phone:641-450-0003
Practice Address - Fax:641-450-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty