Provider Demographics
NPI:1770295958
Name:YOUNG, ZEYAH KENYA (BSW SOCIAL WORKER)
Entity type:Individual
Prefix:MS
First Name:ZEYAH
Middle Name:KENYA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:BSW SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 N VEL R PHILLIPS AVE STE 131A
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2362
Mailing Address - Country:US
Mailing Address - Phone:414-899-1131
Mailing Address - Fax:
Practice Address - Street 1:2821 N VEL R PHILLIPS AVE STE 131A
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2362
Practice Address - Country:US
Practice Address - Phone:414-899-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker