Healthcare Provider Details

I. General information

NPI: 1699293563
Provider Name (Legal Business Name): GEOFFREY K MALONE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N13W28697 SILVERNAIL RD
PEWAUKEE WI
53072-5107
US

IV. Provider business mailing address

N13W28697 SILVERNAIL RD
PEWAUKEE WI
53072-5107
US

V. Phone/Fax

Practice location:
  • Phone: 262-422-8181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9621-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: