Provider Demographics
NPI:1205510518
Name:YOUNG, AUDREY GWEN (EDD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:GWEN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2683
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:TX
Mailing Address - Zip Code:75862-2683
Mailing Address - Country:US
Mailing Address - Phone:936-569-3150
Mailing Address - Fax:
Practice Address - Street 1:421 N FREDONIA ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-5010
Practice Address - Country:US
Practice Address - Phone:936-569-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX337102355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant