Provider Demographics
NPI:1720484611
Name:FISHER-MALONE, NYELA (MS)
Entity Type:Individual
Prefix:
First Name:NYELA
Middle Name:
Last Name:FISHER-MALONE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3062 E 91ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-4401
Mailing Address - Country:US
Mailing Address - Phone:773-932-3513
Mailing Address - Fax:
Practice Address - Street 1:8644 S 86TH AVE
Practice Address - Street 2:113
Practice Address - City:JUSTICE
Practice Address - State:IL
Practice Address - Zip Code:60458-2111
Practice Address - Country:US
Practice Address - Phone:708-546-0806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor