Provider Demographics
NPI:1184282428
Name:YOUNG, EMILY R (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-9077
Mailing Address - Country:US
Mailing Address - Phone:989-573-4762
Mailing Address - Fax:
Practice Address - Street 1:500 SPRING ST SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3773
Practice Address - Country:US
Practice Address - Phone:770-615-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-02
Last Update Date:2019-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010605235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist