Provider Demographics
NPI:1740560077
Name:YOUNG, JENNY LYNN
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:LYNN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JENNY
Other - Middle Name:LYNN
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMI
Mailing Address - Street 1:372 CANDICE DR NW
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-7502
Mailing Address - Country:US
Mailing Address - Phone:405-640-3775
Mailing Address - Fax:
Practice Address - Street 1:372 CANDICE DR NW
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-7502
Practice Address - Country:US
Practice Address - Phone:405-640-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator