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General NPI Number Information
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NPI Number | 1720484611
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Entity Type | Individual
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Provider Name | NYELA FISHER-MALONE MS
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Gender | Female
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 8644 S 86TH AVE 113
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City | JUSTICE
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State | IL
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Zip | 60458-2111
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Country | US
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Telephone | 708-546-0806
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Fax |
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Provider Business Mailing Address
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Address Line | 3062 E 91ST ST
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City | CHICAGO
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State | IL
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Zip | 60617-4401
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Country | US
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Telephone | 773-932-3513
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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