Healthcare Provider Details

I. General information

NPI: 1063087625
Provider Name (Legal Business Name): CELIA YOUNG CCC- SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1958 ELM ST
DENVER CO
80220-1247
US

IV. Provider business mailing address

1450 ALBION ST APT 203
DENVER CO
80220-2378
US

V. Phone/Fax

Practice location:
  • Phone: 303-333-4982
  • Fax: 187-750-6058
Mailing address:
  • Phone: 917-843-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPSLP.0000761
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: