MEDICARE: MRS. MINDY S. YOUNG MA, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP-6063	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487781845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MINDY S. YOUNG MA, CCC-SLP

Provider Business Mailing Address
First Line	:	1909 N RIDGE RD E STE 6
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44055-3379
Country	:	US
Telephone Number	:	440-277-7337
Fax Number	:	440-277-7339

Provider Business Practice Location Address
First Line	:	1909 N RIDGE RD E STE 6
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44055-3379
Country	:	US
Telephone Number	:	440-277-7337
Fax Number	:	440-277-7339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	11/12/2007

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Directions to “ MRS. MINDY S. YOUNG MA, CCC-SLP” Practice Location

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