MEDICARE: SUSANNE TROUT RD, LD, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1004X	Pediatric Nutrition Registered Dietitian	DT06597	TX
2	174400000X	Specialist	106-22905	TX

General Provider Information

NPI Number	:	1780891564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNE TROUT RD, LD, IBCLC

Provider Business Mailing Address
First Line	:	7500 KIRBY DR APT 1634
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4342
Country	:	US
Telephone Number	:	713-660-8996
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 KIRBY DR APT 1634
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4342
Country	:	US
Telephone Number	:	713-660-8996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	09/11/2025

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