Shannon Rae Mallory Hertzog, BS, MS
NPI #1124602560 in Longview, Washington
Provider Information
- NPI Number
- 1124602560
- Entity Type
- Individual
- Name
- Shannon Rae Mallory Hertzog, BS, MS
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Dietitian, Registered
- Credential
- BS, MS
- Enumeration Date
- May 11, 2021
- Last Updated
- Dec 20, 2025
Practice Location
- Address
- 1615 DELAWARE ST
- City
- Longview
- State
- Washington
- ZIP Code
- 98632-2367
- Phone
- (360) 501-3601
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dietitian, Registered |
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