MEDICARE: BRENNA SHAE MALONE BS

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	106S00000X	Behavior Technician	RBT-20-131148	KY
2	103K00000X	Behavior Analyst	1-23-68268	IN

General Provider Information

NPI Number	:	1841805769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENNA SHAE MALONE BS

Provider Business Mailing Address
First Line	:	3006 EASTPOINT PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-4185
Country	:	US
Telephone Number	:	502-795-0773
Fax Number	:	800-990-2526

Provider Business Practice Location Address
First Line	:	2916 PEACH BLOSSOM DR STE 104
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-8380
Country	:	US
Telephone Number	:	812-202-6144
Fax Number	:	800-990-2526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2020
Last Update Date	:	07/16/2025

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