Provider Demographics
NPI:1245414176
Name:YOUNG, ROXANNE MARIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 SE HARVEY ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-5815
Mailing Address - Country:US
Mailing Address - Phone:503-310-4676
Mailing Address - Fax:
Practice Address - Street 1:4180 SE HARVEY ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-5815
Practice Address - Country:US
Practice Address - Phone:503-310-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13821246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other