Provider Demographics
NPI:1508087768
Name:YOUNG, JACQUELINE LEANNE (JACQUELINE YOUNG)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LEANNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:JACQUELINE YOUNG
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:LEANNE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JACQUELINE YOUNG
Mailing Address - Street 1:826 GOLF RD.
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870
Mailing Address - Country:US
Mailing Address - Phone:417-673-5561
Mailing Address - Fax:
Practice Address - Street 1:411 MADISON
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870
Practice Address - Country:US
Practice Address - Phone:417-673-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006029254235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist