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1841805769 NPI number — BRENNA SHAE MALONE BS

NPI Number: 1841805769
Health Care Provider/Practitioner: BRENNA SHAE MALONE BS

Information about “1841805769” NPI (BRENNA SHAE MALONE BS) exists in 1841805769 in HTML format HTML  |  1841805769 in plain Text format TXT  |  1841805769 in PDF (Portable Document Format) PDF  |  1841805769 in an XML format XML  formats.

NPI Number : 1841805769 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1841805769",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MALONE",
    "FirstName": "BRENNA",
    "MiddleName": "SHAE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "BS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3006 EASTPOINT PKWY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOUISVILLE",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "40223-4185",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "502-795-0773",
    "MailingAddressFaxNumber": "800-990-2526",
    "FirstLinePracticeLocationAddress": "2916 PEACH BLOSSOM DR STE 104",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JEFFERSONVILLE",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "47130-8380",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "812-202-6144",
    "PracticeLocationAddressFaxNumber": "800-990-2526",
    "EnumerationDate": "09/09/2020",
    "LastUpdateDate": "07/16/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "106S00000X",
          "TaxonomyName": "Behavior Technician",
          "LicenseNumber": "RBT-20-131148",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "1-23-68268",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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