Provider Demographics
NPI:1780891564
Name:TROUT, SUSANNE (RD, LD, IBCLC)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:TROUT
Suffix:
Gender:F
Credentials:RD, LD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 KIRBY DR APT 1634
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4342
Mailing Address - Country:US
Mailing Address - Phone:713-660-8996
Mailing Address - Fax:
Practice Address - Street 1:7500 KIRBY DR APT 1634
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4342
Practice Address - Country:US
Practice Address - Phone:713-660-8996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06597133VN1004X
TX106-22905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Not Answered174400000XOther Service ProvidersSpecialist