Mallory H Baerenwald, MS,RD,CD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

3465-29 Issued in WI

Practice address

3263 Eaton Rd
Green Bay, WI 54311-6830

Phone

(920) 433-6700

Fax

(920) 433-6719

NPI assigned

Nov 5, 2019

Last updated

Apr 18, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mallory H Krueger Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bellin Memorial Hospital Inc

  dba Bellin Health Algoma

  • Rural Health Clinic/Center
  • Algoma, WI
  • NPI 1609838473
  NPD
• Oconto Hospital & Medical Center Inc

  dba Emplify Health Oconto Hospital

  • Critical Access Hospital
  • Oconto, WI
  • NPI 1356373302
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650240000000",
    "number": "1548804370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3263 EATON RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543116830",
            "telephone_number": "920-433-6700",
            "fax_number": "920-433-6719"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2820 Roosevelt Rd",
            "address_purpose": "LOCATION",
            "city": "Marinette",
            "state": "WI",
            "postal_code": "541433834",
            "country_code": "US",
            "telephone_number": "715-735-5225",
            "fax_number": "715-735-5388",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "107 E Highland Dr",
            "address_purpose": "LOCATION",
            "city": "Oconto Falls",
            "state": "WI",
            "postal_code": "541541002",
            "country_code": "US",
            "telephone_number": "920-846-3092",
            "fax_number": "920-846-8313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAERENWALD",
        "first_name": "MALLORY",
        "middle_name": "H",
        "credential": "MS,RD,CD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-05",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WI",
            "license": "3465-29",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMISSION ON DIETETIC REGISTRATION",
            "identifier": "86087767",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "KRUEGER",
            "middle_name": "H",
            "credential": "MS,RD,CD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shawn B Backus, LPN
• Trisha Ann Backus, RN
• Eric J Bader, PT
• Melissa Elnora Bader, NP
• Paul N Baek, MD
• Baeten Counseling & Consultation Team, S.C.
• Brianna Lynn Baeten, PA
• Pamela C Baeten, M.D.
• Tina Marie Baeten, LCSW
• Kathleen J Bahler, MSSW ACSW LSW

• Registered Dietitian in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Registered Dietitian in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.