Individual
MALLORY H BAERENWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,RD,CD
Contact information
Practice address
3263 EATON RD, GREEN BAY, WI 54311-6830
(920) 433-6700
(920) 433-6719
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
3465-29
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86087767
COMMISSION ON DIETETIC REGISTRATION
—
Enumeration date
11/05/2019
Last updated
04/18/2022
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