Provider Demographics
NPI:1184780314
Name:YOUNG, PATRICIA JANEAN (MA)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JANEAN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31935 CALLE ESPINOSA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-3743
Mailing Address - Country:US
Mailing Address - Phone:951-303-9422
Mailing Address - Fax:951-303-9432
Practice Address - Street 1:31935 CALLE ESPINOSA
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-3743
Practice Address - Country:US
Practice Address - Phone:951-303-9422
Practice Address - Fax:951-303-9432
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP0048140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2064835Medicaid
CAGSP000570Medicaid