Healthcare Provider Details

I. General information

NPI: 1750204665
Provider Name (Legal Business Name): MAUREEN MCNALLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2468 SOUTH KINNICKINNIC AVENUE UNIT 301
MILWAUKEE WI
53217
US

IV. Provider business mailing address

2468 SOUTH KINNICKINNIC AVENUE UNIT 301
MILWAUKEE WI
53217
US

V. Phone/Fax

Practice location:
  • Phone: 414-943-1739
  • Fax:
Mailing address:
  • Phone: 414-943-1739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9217226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: