Healthcare Provider Details

I. General information

NPI: 1275442436
Provider Name (Legal Business Name): BRANDI YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23515 MAUD AVE
FAIRVIEW CA
94541-4519
US

IV. Provider business mailing address

456 WAYNE AVE APT 209
OAKLAND CA
94606-1113
US

V. Phone/Fax

Practice location:
  • Phone: 510-723-3830
  • Fax:
Mailing address:
  • Phone: 510-723-3830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: