MEDICARE: MARIENDA NUTRITION LLC

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1497682488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIENDA NUTRITION LLC

Provider Business Mailing Address
First Line	:	1828 W ELLEN ST APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3373
Country	:	US
Telephone Number	:	608-426-4851
Fax Number	:

Provider Business Practice Location Address
First Line	:	1828 W ELLEN ST APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3373
Country	:	US
Telephone Number	:	608-426-4851
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MADELINE KALLGREN
Credential	:	RDN, LDN
Telephone Number	:	608-426-4851

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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Directions to “MARIENDA NUTRITION LLC ” Practice Location

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