Provider Demographics
NPI:1821103243
Name:YOUNG, NANCY F (MA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:F
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 TONYAWATHA TRL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-2501
Mailing Address - Country:US
Mailing Address - Phone:608-221-4030
Mailing Address - Fax:608-221-1143
Practice Address - Street 1:715 HILL ST
Practice Address - Street 2:QUARRY ARTS BLDG. #160
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3542
Practice Address - Country:US
Practice Address - Phone:608-256-0942
Practice Address - Fax:609-221-1143
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI224-058103TS0200X
WI24-124106H00000X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical