Provider Demographics
NPI:1093211153
Name:GRENDA, BRANDEE JOY (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:BRANDEE
Middle Name:JOY
Last Name:GRENDA
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MISS
Other - First Name:BRANDEE
Other - Middle Name:JOY
Other - Last Name:LANDRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11625 S KENNETH AVE
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-2131
Mailing Address - Country:US
Mailing Address - Phone:708-878-3969
Mailing Address - Fax:
Practice Address - Street 1:5645 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4403
Practice Address - Country:US
Practice Address - Phone:773-282-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.550023133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered