Provider Demographics
NPI:1356168124
Name:KILLEY, YOUNG
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:
Last Name:KILLEY
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 1:175 1ST PL NW APT 110
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2745
Mailing Address - Country:US
Mailing Address - Phone:907-687-0780
Mailing Address - Fax:
Practice Address - Street 1:175 1ST PL NW APT 110
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2745
Practice Address - Country:US
Practice Address - Phone:425-757-2041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604108816171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter