Healthcare Provider Details

I. General information

NPI: 1760756340
Provider Name (Legal Business Name): KRISTAL DANIELLE YOUNG M.S., CCC-SLP, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 W BOND AVE
WEST MEMPHIS AR
72301-3907
US

IV. Provider business mailing address

5687 PORT STACY DR
HORN LAKE MS
38637-4404
US

V. Phone/Fax

Practice location:
  • Phone: 662-590-3581
  • Fax:
Mailing address:
  • Phone: 662-590-3581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4340
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: