Provider Demographics
NPI:1174884027
Name:YOUNG, MICHELLE LYNNE (MS ED)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13275 DORSCH RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-9575
Mailing Address - Country:US
Mailing Address - Phone:716-864-5438
Mailing Address - Fax:
Practice Address - Street 1:13275 DORSCH RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:NY
Practice Address - Zip Code:14001-9575
Practice Address - Country:US
Practice Address - Phone:716-864-5438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86566071174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist