Provider Demographics
NPI:1356349419
Name:GENENZ, DANIELLE ANNE (MS, RD, LDN, CPT)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ANNE
Last Name:GENENZ
Suffix:
Gender:F
Credentials:MS, RD, LDN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 N CUMBERLAND AVE
Mailing Address - Street 2:STE 225
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1531
Mailing Address - Country:US
Mailing Address - Phone:847-640-4440
Mailing Address - Fax:847-437-2770
Practice Address - Street 1:5440 N CUMBERLAND AVE
Practice Address - Street 2:STE 225
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1531
Practice Address - Country:US
Practice Address - Phone:847-640-4440
Practice Address - Fax:847-437-2770
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164003059133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered