MEDICARE: MALECK THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1871936401	OTHER	WI	NPI
2	1730569989	OTHER	WI	NPI
3	1083289557	OTHER	WI	NPI

General Provider Information

NPI Number	:	1114480878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALECK THERAPY, LLC

Provider Business Mailing Address
First Line	:	5609 MEDICAL CIR STE 201
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-1228
Country	:	US
Telephone Number	:	608-514-1625
Fax Number	:	608-398-8881

Provider Business Practice Location Address
First Line	:	5609 MEDICAL CIR STE 201
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-1228
Country	:	US
Telephone Number	:	608-514-1625
Fax Number	:	608-398-8881

Authorized Official
Title or Position	:	LPC, LMFT
Name	:	SARAH MALECK
Credential	:	MS
Telephone Number	:	608-514-1625

Provider Enumeration Date	:	04/10/2019
Last Update Date	:	08/27/2025

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