Provider Demographics
NPI:1447245477
Name:YOUNGMAN, PATRICIA KAY (MS CCC SP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:KAY
Last Name:YOUNGMAN
Suffix:
Gender:F
Credentials:MS CCC SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1113
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0042
Mailing Address - Country:US
Mailing Address - Phone:206-619-2263
Mailing Address - Fax:206-365-1428
Practice Address - Street 1:10740 MERIDIAN AVE N
Practice Address - Street 2:STE 104
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9010
Practice Address - Country:US
Practice Address - Phone:206-619-2263
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
WALL00001792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA106776OtherLABOR & INDUSTRIES
WAY05376OtherREGENCE BLUE SHIELD
WA8906471OtherCRIME VICTIMS