# WILLOWGLEN ACADEMY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Willowglen Academy Outpatient Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619147048
- **Authorized official:** SHANNA MALONEY LCSW (DIRECTOR OF OUTPATIENT SERVICES)
- **Authorized official phone:** (414) 445-9180

## Contact information

- **Practice address:** 4065 N 35TH ST, SUITE N100, MILWAUKEE, WI 53216-1705
- **Practice address phone:** (414) 445-9180
- **Practice address fax:** (414) 445-5995
- **Mailing address:** 4065 N 35TH ST, SUITE N100, MILWAUKEE, WI 53216-1705
- **Mailing address phone:** (414) 445-9180
- **Mailing address fax:** (414) 445-5995

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 2004 | WI | Yes |

## Other

- **Enumeration date:** 02/29/2008
- **Last updated:** 06/19/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 42167200 | — | WI |