Healthcare Provider Details

I. General information

NPI: 1891633368
Provider Name (Legal Business Name): MALORIE SUE ANN CLASEN LPC-IT, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N JACKSON ST
MILWAUKEE WI
53202-2602
US

IV. Provider business mailing address

1675 N 116TH ST
WAUWATOSA WI
53226-3001
US

V. Phone/Fax

Practice location:
  • Phone: 414-390-5800
  • Fax:
Mailing address:
  • Phone: 414-651-4903
  • Fax: 414-651-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: