Provider Demographics
NPI:1235403007
Name:MALONE, SHANNON JOY (MS/CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:JOY
Last Name:MALONE
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6142
Mailing Address - Country:US
Mailing Address - Phone:715-832-1681
Mailing Address - Fax:
Practice Address - Street 1:2120 HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6142
Practice Address - Country:US
Practice Address - Phone:715-832-1681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-26
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1449-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist