Provider Demographics
NPI:1013109404
Name:YOUNT, CARISSA D (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:D
Last Name:YOUNT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:BOEHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 WINDING VIEW TRAIL
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324
Mailing Address - Country:US
Mailing Address - Phone:859-559-5538
Mailing Address - Fax:866-465-1499
Practice Address - Street 1:101 WINDING VIEW TRAIL
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:04324
Practice Address - Country:US
Practice Address - Phone:859-559-5538
Practice Address - Fax:508-996-3397
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7074235Z00000X
KY143469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist