Provider Demographics
NPI:1164929964
Name:YOUNGDAHL, LORIN N (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORIN
Middle Name:N
Last Name:YOUNGDAHL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MRS
Other - First Name:LORIN
Other - Middle Name:N
Other - Last Name:YOUNGDAHL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:4000 VACATION LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-3933
Mailing Address - Country:US
Mailing Address - Phone:703-228-6363
Mailing Address - Fax:
Practice Address - Street 1:4000 VACATION LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-3933
Practice Address - Country:US
Practice Address - Phone:703-228-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist