Provider Demographics
NPI:1851072730
Name:YOUNG, AICACIA (RDN)
Entity Type:Individual
Prefix:
First Name:AICACIA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7016 HALESBORO DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736-1756
Mailing Address - Country:US
Mailing Address - Phone:512-294-1932
Mailing Address - Fax:
Practice Address - Street 1:7016 HALESBORO DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78736-1756
Practice Address - Country:US
Practice Address - Phone:512-294-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered