Provider Demographics
NPI:1659657435
Name:YOUNG, BRIANNE BRIDGET (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:BRIDGET
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:BRIANNE
Other - Middle Name:BRIDGET
Other - Last Name:FOGARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:125 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RENFREW
Mailing Address - State:PA
Mailing Address - Zip Code:16053-1213
Mailing Address - Country:US
Mailing Address - Phone:724-448-0883
Mailing Address - Fax:
Practice Address - Street 1:125 MEADOWBROOK RD
Practice Address - Street 2:
Practice Address - City:RENFREW
Practice Address - State:PA
Practice Address - Zip Code:16053-1213
Practice Address - Country:US
Practice Address - Phone:724-448-0883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010643235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist