Provider Demographics
NPI:1164738175
Name:YOUNGMAN, ANN (HIS)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:YOUNGMAN
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-4497
Mailing Address - Country:US
Mailing Address - Phone:309-696-4268
Mailing Address - Fax:309-693-2776
Practice Address - Street 1:2412 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-4497
Practice Address - Country:US
Practice Address - Phone:309-696-4268
Practice Address - Fax:309-693-2776
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILY525-0528-2707237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist