Provider Demographics
NPI:1982846390
Name:YOUNG, JENNIFER MARIE (AUD, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 FOREST AVE STE 227
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4933
Mailing Address - Country:US
Mailing Address - Phone:804-358-5851
Mailing Address - Fax:804-284-1278
Practice Address - Street 1:7601 FOREST AVE STE 227
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4933
Practice Address - Country:US
Practice Address - Phone:804-358-5851
Practice Address - Fax:804-284-1278
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR030826231H00000X
NC5249231H00000X
NC1002237600000X
VA237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2047100Medicaid
OR500690465Medicaid
OR182090Medicare PIN
OR500690465Medicaid