Provider Demographics
NPI:1093079808
Name:YOUNG, ANDREW THOMAS (AUD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:THOMAS
Last Name:YOUNG
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13336 INDUSTRIAL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1124
Mailing Address - Country:US
Mailing Address - Phone:402-330-3211
Mailing Address - Fax:402-330-5970
Practice Address - Street 1:13336 INDUSTRIAL RD STE 105
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137
Practice Address - Country:US
Practice Address - Phone:402-330-3211
Practice Address - Fax:402-330-5970
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO201209713231H00000X
NE305231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist