Healthcare Provider Details

I. General information

NPI: 1497682488
Provider Name (Legal Business Name): MARIENDA NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 W ELLEN ST APT 2
CHICAGO IL
60622-3373
US

IV. Provider business mailing address

1828 W ELLEN ST APT 2
CHICAGO IL
60622-3373
US

V. Phone/Fax

Practice location:
  • Phone: 608-426-4851
  • Fax:
Mailing address:
  • Phone: 608-426-4851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MADELINE KALLGREN
Title or Position: OWNER
Credential: RDN, LDN
Phone: 608-426-4851