Provider Demographics
NPI:1073161915
Name:YOUNGS, JESSICA (LAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:YOUNGS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1344
Mailing Address - Country:US
Mailing Address - Phone:330-618-8273
Mailing Address - Fax:
Practice Address - Street 1:307 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1344
Practice Address - Country:US
Practice Address - Phone:330-618-8273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-371171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDACU-371OtherACUPUNCTURE LICENSE