Provider Demographics
NPI:1114189537
Name:YOUNG, JOHN PATRICK (MA,CCC-A)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PATRICK
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 59325
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-2325
Mailing Address - Country:US
Mailing Address - Phone:425-204-6958
Mailing Address - Fax:206-523-5882
Practice Address - Street 1:9714 3RD AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2044
Practice Address - Country:US
Practice Address - Phone:206-523-5584
Practice Address - Fax:206-523-5882
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00004418231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist