Provider Demographics
NPI:1376722397
Name:COLLEEN K YOUNG
Entity Type:Organization
Organization Name:COLLEEN K YOUNG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LND
Authorized Official - Phone:610-664-5858
Mailing Address - Street 1:114 FORREST AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2218
Mailing Address - Country:US
Mailing Address - Phone:610-664-5858
Mailing Address - Fax:610-664-5250
Practice Address - Street 1:114 FORREST AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2218
Practice Address - Country:US
Practice Address - Phone:610-664-5858
Practice Address - Fax:610-664-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADNOO3248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty