MEDICARE: ASHLEY LAUREN YOUNG

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	2255A2300X	Athletic Trainer
2	2255A2300X	Athletic Trainer	115086	IA

General Provider Information

NPI Number	:	1891439345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY LAUREN YOUNG

Provider Business Mailing Address
First Line	:	12650 JACKSON BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29207-6129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12650 JACKSON BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29207-6129
Country	:	US
Telephone Number	:	317-447-9679
Fax Number	:

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

Provider Enumeration Date	:	04/21/2022
Last Update Date	:	11/29/2023

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Directions to “ ASHLEY LAUREN YOUNG ” Practice Location

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