Provider Demographics
NPI:1255676953
Name:MALM, SHEENA G (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:SHEENA
Middle Name:G
Last Name:MALM
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:SHEENA
Other - Middle Name:
Other - Last Name:WICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:DRESSER
Mailing Address - State:WI
Mailing Address - Zip Code:54009-9065
Mailing Address - Country:US
Mailing Address - Phone:715-494-0004
Mailing Address - Fax:
Practice Address - Street 1:401 ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:DRESSER
Practice Address - State:WI
Practice Address - Zip Code:54009-9065
Practice Address - Country:US
Practice Address - Phone:715-494-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01728101YM0800X
WI5602125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health