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General NPI Number Information
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NPI Number | 1841805769
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Entity Type | Individual
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Provider Name | BRENNA SHAE MALONE BS
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Gender | Female
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 2916 PEACH BLOSSOM DR STE 104
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-8380
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Country | US
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Telephone | 812-202-6144
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Fax | 800-990-2526
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Provider Business Mailing Address
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Address Line | 3006 EASTPOINT PKWY
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City | LOUISVILLE
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State | KY
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Zip | 40223-4185
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Country | US
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Telephone | 502-795-0773
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Fax | 800-990-2526
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-20-131148
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-23-68268
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License Number State | IN
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