Provider Demographics
NPI:1477653459
Name:YOUNG, KRISTYN KELLY (SLP)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:KELLY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3189 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2732
Mailing Address - Country:US
Mailing Address - Phone:304-522-3935
Mailing Address - Fax:
Practice Address - Street 1:1 JOHN MARSHALL DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25755-1428
Practice Address - Country:US
Practice Address - Phone:304-696-3641
Practice Address - Fax:304-696-2986
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSPL-0847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist