Healthcare Provider Details

I. General information

NPI: 1033081484
Provider Name (Legal Business Name): VANESSA YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 24TH AVE
SANTA CRUZ CA
95062-4205
US

IV. Provider business mailing address

1187 COAST VILLAGE RD STE 171
MONTECITO CA
93108-2737
US

V. Phone/Fax

Practice location:
  • Phone: 831-475-6323
  • Fax:
Mailing address:
  • Phone: 805-792-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17864
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: