Provider Demographics
NPI:1619696770
Name:YOUNG-MARKEY, SUSAN L (CTRS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:YOUNG-MARKEY
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:YOUNG-MARKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CTRS
Mailing Address - Street 1:500 NORTH HIGHWAY 89
Mailing Address - Street 2:CLC BUILDING 148 ROOM A105
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86313
Mailing Address - Country:US
Mailing Address - Phone:928-445-4860
Mailing Address - Fax:
Practice Address - Street 1:500 NORTH HIGHWAY 89
Practice Address - Street 2:CLC BUILDING 148 ROOM A105
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313
Practice Address - Country:US
Practice Address - Phone:928-445-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
23258225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist