Healthcare Provider Details

I. General information

NPI: 1578636965
Provider Name (Legal Business Name): KATHY L GRZENDZIELEWSKI RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W180N8085 TOWN HALL RD
MENOMONEE FALLS WI
53051-3518
US

IV. Provider business mailing address

19305 W HIGHLAND DR
NEW BERLIN WI
53146-5004
US

V. Phone/Fax

Practice location:
  • Phone: 262-257-3643
  • Fax:
Mailing address:
  • Phone: 262-312-0870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number69
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: