Provider Demographics
NPI:1356221840
Name:KRANENDONK, MADALYN LAVISE (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:MADALYN
Middle Name:LAVISE
Last Name:KRANENDONK
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:MADALYN
Other - Middle Name:LAVISE
Other - Last Name:ROEHRIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN, LD
Mailing Address - Street 1:5859 FRANKFORD RD APT 803
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5376
Mailing Address - Country:US
Mailing Address - Phone:972-322-5571
Mailing Address - Fax:
Practice Address - Street 1:5120 LEGACY DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3399
Practice Address - Country:US
Practice Address - Phone:469-613-1722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT92060133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered