Provider Demographics
NPI:1891293908
Name:YOUNG, NANCI CHERYLL (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NANCI
Middle Name:CHERYLL
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-1307
Mailing Address - Country:US
Mailing Address - Phone:870-892-4573
Mailing Address - Fax:870-892-8857
Practice Address - Street 1:2301 N PARK ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-1307
Practice Address - Country:US
Practice Address - Phone:870-892-4573
Practice Address - Fax:870-892-8857
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP834235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist