Shannon Rae Mallory Hertzog, BS, MS - Dietitian in Battle Ground, WA

  1. Home
  2. Dietitians
  3. WA
  4. Battle Ground
Shannon Rae Mallory Hertzog, BS, MS is a Dietitian, Registered based in Battle Ground, Washington. Shannon Rae Mallory Hertzog is licensed to practice in Washington (license number DI61176521) and her current practice location is 2005 W Main St Ste 130, Battle Ground, Washington. She can be reached at her office (for appointments etc.) via phone at (360) 882-2778.

NPI number for Shannon Rae Mallory Hertzog is 1124602560 and her current mailing address is 700 Ne 87th Ave, Vancouver, Washington. She does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1124602560.

Contact Information

Shannon Rae Mallory Hertzog, BS, MS
2005 W Main St Ste 130,
Battle Ground, WA 98604-4311
(360) 882-2778
(360) 604-1785

Map and Direction




Healthcare Provider's Profile

Full NameShannon Rae Mallory Hertzog
GenderFemale
SpecialityDietitian, Registered
Location2005 W Main St Ste 130, Battle Ground, Washington
Accepts Medicare AssignmentsDoes not participate in Medicare Program. She may not accept medicare assignment.
  NPI Data:
  • NPI Number: 1124602560
  • Provider Enumeration Date: 05/11/2021
  • Last Update Date: 05/11/2021

Medical Identifiers

Medical identifiers for Shannon Rae Mallory Hertzog such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1124602560NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
133V00000XDietitian, Registered DI61176521 (Washington)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shannon Rae Mallory Hertzog is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Shannon Rae Mallory Hertzog, BS, MS
700 Ne 87th Ave,
Vancouver, WA 98664-4896

Ph: (360) 882-2778		Shannon Rae Mallory Hertzog, BS, MS
2005 W Main St Ste 130,
Battle Ground, WA 98604-4311

Ph: (360) 882-2778

Reviews and Comments


Dietitian, Registered in Battle Ground, WA

Sea Mar Community Health Centers
Dietitian
Medicare: Not Enrolled in Medicare
Practice Location: 701 E Main St, Battle Ground, WA 98604
Phone: 360-213-1340    Fax: 360-687-7694

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.