Provider Demographics
NPI:1184232829
Name:YOUNG, MARLENA (HAIR LOSS CERTIFICAT)
Entity type:Individual
Prefix:
First Name:MARLENA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:HAIR LOSS CERTIFICAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20141 BRAMFORD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-3201
Mailing Address - Country:US
Mailing Address - Phone:678-615-5908
Mailing Address - Fax:
Practice Address - Street 1:20141 BRAMFORD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3201
Practice Address - Country:US
Practice Address - Phone:678-615-5908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI27013516891744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management