Provider Demographics
NPI:1902227416
Name:YOUNG, KATHERINE (LMT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 HAVEN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-2432
Mailing Address - Country:US
Mailing Address - Phone:541-944-0344
Mailing Address - Fax:
Practice Address - Street 1:836 E MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7115
Practice Address - Country:US
Practice Address - Phone:541-773-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11439171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor