Provider Demographics
NPI:1598335861
Name:YOUNG, SELENA (SLPA)
Entity Type:Individual
Prefix:MS
First Name:SELENA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:MS
Other - First Name:SELENA
Other - Middle Name:
Other - Last Name:CHIN-YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:YAN CHEE CHIN
Mailing Address - Street 1:7090 MIRATECH DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3109
Mailing Address - Country:US
Mailing Address - Phone:858-304-9664
Mailing Address - Fax:
Practice Address - Street 1:7090 MIRATECH DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3109
Practice Address - Country:US
Practice Address - Phone:858-304-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist