Provider Demographics
NPI:1225402977
Name:YOUNG, BLAKELEE ALYSSA (BS)
Entity Type:Individual
Prefix:MISS
First Name:BLAKELEE
Middle Name:ALYSSA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S JOHN ST
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:AR
Mailing Address - Zip Code:71639-2432
Mailing Address - Country:US
Mailing Address - Phone:870-377-2476
Mailing Address - Fax:
Practice Address - Street 1:123 S JOHN ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:AR
Practice Address - Zip Code:71639-2432
Practice Address - Country:US
Practice Address - Phone:870-377-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist