Provider Demographics
NPI:1992863468
Name:YOUNG, GESSYKA (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:GESSYKA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:GESSYKA
Other - Middle Name:
Other - Last Name:GUERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,CCC/SLP
Mailing Address - Street 1:400 GUNSTON HALL DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-7504
Mailing Address - Country:US
Mailing Address - Phone:407-701-5910
Mailing Address - Fax:
Practice Address - Street 1:9880 HICKORY FLAT HWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3081
Practice Address - Country:US
Practice Address - Phone:770-800-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7117235Z00000X
GASLP008482235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888719500Medicaid