Healthcare Provider Details

I. General information

NPI: 1740531292
Provider Name (Legal Business Name): RUTH YOUNG SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8112 W VINCENT LN
CRYSTAL RIVER FL
34428-6914
US

IV. Provider business mailing address

8112 W VINCENT LN
CRYSTAL RIVER FL
34428-6914
US

V. Phone/Fax

Practice location:
  • Phone: 337-366-4544
  • Fax:
Mailing address:
  • Phone: 337-366-4544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA19119
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: