Healthcare Provider Details

I. General information

NPI: 1982931713
Provider Name (Legal Business Name): YETHA D MALONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YETHA D PARKS

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3590 S MELON DR
SAINT ANNE IL
60964-6201
US

IV. Provider business mailing address

3590 S MELON DR
SAINT ANNE IL
60964-6201
US

V. Phone/Fax

Practice location:
  • Phone: 708-945-8258
  • Fax: 815-933-2494
Mailing address:
  • Phone: 708-945-8258
  • Fax: 815-933-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: