Provider Demographics
NPI:1720578594
Name:YOUNG, JENELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENELLE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 OLD BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019-3128
Mailing Address - Country:US
Mailing Address - Phone:781-820-0008
Mailing Address - Fax:
Practice Address - Street 1:37 BIRCH ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-5501
Practice Address - Country:US
Practice Address - Phone:508-473-0862
Practice Address - Fax:508-473-3229
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7708235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist