Provider Demographics
NPI:1912719345
Name:MALONEY, SHAUNA COLLEEN (MS)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:COLLEEN
Last Name:MALONEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 BROADWAY ST N STE 114
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-4728
Mailing Address - Country:US
Mailing Address - Phone:715-619-6736
Mailing Address - Fax:888-972-4831
Practice Address - Street 1:1421 BROADWAY ST N STE 114
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-4728
Practice Address - Country:US
Practice Address - Phone:715-619-6736
Practice Address - Fax:888-972-4831
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional