Organization
WILLOWGLEN ACADEMY INC
Active
Other names
Willowglen Academy Outpatient Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNA MALONEY LCSW (DIRECTOR OF OUTPATIENT SERVICES)
(414) 445-9180
Entity
Organization
Contact information
Practice address
4065 N 35TH ST, SUITE N100, MILWAUKEE, WI 53216-1705
(414) 445-9180
(414) 445-5995
Mailing address
4065 N 35TH ST, SUITE N100, MILWAUKEE, WI 53216-1705
(414) 445-9180
(414) 445-5995
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2004
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42167200
—
WI
Enumeration date
02/29/2008
Last updated
06/19/2014
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