Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shannon Rae Mallory Hertzog, BS, MS

Individual provider Registered Dietitian · NPI 1124602560

Shannon Rae Mallory Hertzog, BS, MS is a Registered Dietitian in Longview, Washington. Works from 2 locations. Licensed in Washington.

Licensed in
WA
In the registry since
2021
What do these letters mean?
BS — Bachelor of Science
An undergraduate science degree.
MS — Master of Science
A graduate science degree.

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Practice location Address checks out

1615 Delaware St
Longview, WA 98632-2367
Phone: (360) 501-3601
Fax: (360) 501-3648
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

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

Specialties & licences

Registered Dietitian (primary) Taxonomy 133V00000X · Licence DI61176521 (WA)

Record details

NPI number1124602560
Entity typeIndividual (Type 1)
GenderFemale
Credentials BS , MS
Sole proprietorNo
NPI enumeratedMay 11, 2021
Last updated in NPPESDecember 20, 2025
Certification dateDecember 20, 2025

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