Provider Demographics
NPI:1548563810
Name:YOUNG, DAWN MARIE (AUD, FAAA)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:AUD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W QUINN ROAD
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83202
Mailing Address - Country:US
Mailing Address - Phone:208-238-4060
Mailing Address - Fax:208-238-4061
Practice Address - Street 1:305 W QUINN ROAD
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83202
Practice Address - Country:US
Practice Address - Phone:208-238-4060
Practice Address - Fax:208-238-4061
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1274231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist