Provider Demographics
NPI:1528566536
Name:YOUNG, KYLIE M (AUD)
Entity Type:Individual
Prefix:DR
First Name:KYLIE
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1906
Mailing Address - Country:US
Mailing Address - Phone:937-548-4242
Mailing Address - Fax:
Practice Address - Street 1:303 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1906
Practice Address - Country:US
Practice Address - Phone:937-548-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA02018231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA02018OtherOHIO BOARD OF SPEECH, LANGUAGE, PATHOLOGY & AUDIOLOGY