Provider Demographics
NPI:1134752686
Name:SPENDLOVE, MALLORY (MDA, RDN)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:SPENDLOVE
Suffix:
Gender:F
Credentials:MDA, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84767-0908
Mailing Address - Country:US
Mailing Address - Phone:801-719-1180
Mailing Address - Fax:
Practice Address - Street 1:1416 ZION PARK BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:UT
Practice Address - Zip Code:84767-7765
Practice Address - Country:US
Practice Address - Phone:801-719-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered