Provider Demographics
NPI:1568611671
Name:PARK, SOYOUNG (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:SOYOUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9031 WHISPERING WIND RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-9280
Mailing Address - Country:US
Mailing Address - Phone:510-912-1585
Mailing Address - Fax:
Practice Address - Street 1:9031 WHISPERING WIND RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-9280
Practice Address - Country:US
Practice Address - Phone:510-912-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13075235Z00000X
NE2021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist