Individual provider · Type 1 NPI

Shannon Rae Mallory Hertzog, BS, MS

Registered Dietitian · Longview, WA

NPI number 1124602560 Active

Practice location

1615 Delaware St
Longview, WA 98632-2367

Call (360) 501-3601 Map

Fax (360) 501-3648

Mailing address

700 NE 87th Ave
Vancouver, WA 98664-4896

Other practice locations

  • 2005 W Main St Ste 130, Battle Ground, WA 98604-4311 · (360) 882-2778

Specialties and licenses

TaxonomyCodeLicense
Registered Dietitian Primary 133V00000XDI61176521 (WA)

Registered Dietitian: A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the…

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About NPI 1124602560

Shannon Rae Mallory Hertzog, BS, MS's National Provider Identifier is 1124602560, issued on May 11, 2021. The primary taxonomy on file is Registered Dietitian (133V00000X), and the practice location is in Longview, WA. The record was last updated on Dec 20, 2025.