Healthcare Provider Details

I. General information

NPI: 1386269272
Provider Name (Legal Business Name): KELLY YOUNG CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 MADERA ST
LEMON GROVE CA
91945-3525
US

IV. Provider business mailing address

8025 LINCOLN ST
LEMON GROVE CA
91945-2515
US

V. Phone/Fax

Practice location:
  • Phone: 619-825-5621
  • Fax:
Mailing address:
  • Phone: 619-825-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number27397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: