Malone, Sandra J.

Malone, Sandra J. is an individual health care provider with primary practice located at 2108 63Rd St , Kenosha WI 53143-4454. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Malone, Sandra J. can be contacted via phone (262) 652-2406.

Contact Information

Primary practice address
2108 63Rd St Kenosha WI 53143-4454
Fax: (262) 652-2408
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 10893-132 Wisconsin

Profile Details

NPI number 1265642714
LBN Legal business name Malone, Sandra J.
Credentials CSAC
Entity Individual
Sole proprietor 1 No
Enumeration date May 23rd, 2007
Last updated Jun 30th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265642714 NPPES
Wisconsin MEDICAID 39390900

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