Provider Demographics
NPI:1619008208
Name:YOUNG, DEBORAH D (HEARING AID PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:D
Last Name:YOUNG
Suffix:
Gender:F
Credentials:HEARING AID PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 LAKE AVE
Mailing Address - Street 2:#714
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-1576
Mailing Address - Country:US
Mailing Address - Phone:216-221-0085
Mailing Address - Fax:216-712-6201
Practice Address - Street 1:14233 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4461
Practice Address - Country:US
Practice Address - Phone:216-533-5403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00636332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0954187Medicaid