Provider Demographics
NPI:1952609240
Name:MALONEY, SHANNA LI (CSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:LI
Last Name:MALONEY
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4065 N 35TH ST
Mailing Address - Street 2:SUITE N100
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1705
Mailing Address - Country:US
Mailing Address - Phone:414-445-9180
Mailing Address - Fax:414-445-5995
Practice Address - Street 1:4065 N 35TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1705
Practice Address - Country:US
Practice Address - Phone:414-445-9180
Practice Address - Fax:414-445-5995
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8120-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical