Provider Demographics
NPI:1336392240
Name:YOUNG, JILL SEDDON
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SEDDON
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S DOLLAR ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3936
Mailing Address - Country:US
Mailing Address - Phone:208-660-8550
Mailing Address - Fax:208-575-0780
Practice Address - Street 1:515 S DOLLAR ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3936
Practice Address - Country:US
Practice Address - Phone:208-660-8550
Practice Address - Fax:208-575-0780
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
1-21-54234103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst