Individual
BRENNA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RDN, LDN
Contact information
Practice address
1339 N DEARBORN ST APT 3A, CHICAGO, IL 60610-6014
(734) 968-6185
Mailing address
1339 N DEARBORN ST APT 3A, CHICAGO, IL 60610-6014
(734) 968-6185
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.007764
IL
Other
Enumeration date
07/09/2019
Last updated
07/09/2019
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