Provider Demographics
NPI:1497028658
Name:YOUNG, CAROLYN ELAINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ELAINE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ELAINE
Other - Last Name:BEARDSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:AL
Mailing Address - Zip Code:35470-0006
Mailing Address - Country:US
Mailing Address - Phone:205-575-1609
Mailing Address - Fax:205-575-1609
Practice Address - Street 1:1502 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:AL
Practice Address - Zip Code:36744-1552
Practice Address - Country:US
Practice Address - Phone:334-624-3950
Practice Address - Fax:334-624-3960
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist