Individual
SHANNON RAE MALLORY HERTZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS, MS
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 501-3601
(360) 501-3648
Mailing address
700 NE 87TH AVE, VANCOUVER, WA 98664-4896
(360) 882-2778
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI61176521
WA
Other
Enumeration date
05/11/2021
Last updated
12/20/2025
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