Provider Demographics
NPI:1942406913
Name:BRINKLEYYOUNG, MELANIE CAROLINE (SLPD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:CAROLINE
Last Name:BRINKLEYYOUNG
Suffix:
Gender:F
Credentials:SLPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:AYDLETT
Mailing Address - State:NC
Mailing Address - Zip Code:27916-0060
Mailing Address - Country:US
Mailing Address - Phone:252-453-9239
Mailing Address - Fax:
Practice Address - Street 1:170 TABERNACLE LN.
Practice Address - Street 2:
Practice Address - City:AYDLETT
Practice Address - State:NC
Practice Address - Zip Code:27916-0060
Practice Address - Country:US
Practice Address - Phone:252-453-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3316235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211762Medicaid
NC7412314Medicaid