Provider Demographics
NPI:1770768137
Name:YOUNGMAN, HEATHER STANHAUS (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:STANHAUS
Last Name:YOUNGMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-2955
Mailing Address - Country:US
Mailing Address - Phone:312-339-0812
Mailing Address - Fax:
Practice Address - Street 1:318 PRINCE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-2955
Practice Address - Country:US
Practice Address - Phone:312-339-0812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007872235Z00000X
MA7631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist