Healthcare Provider Details

I. General information

NPI: 1518201003
Provider Name (Legal Business Name): LEANN YOUNG M.S., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 3RD AVE S
PAYETTE ID
83661-2832
US

IV. Provider business mailing address

1017 W ASHBY DR
MERIDIAN ID
83646-6055
US

V. Phone/Fax

Practice location:
  • Phone: 208-642-4455
  • Fax: 208-642-1315
Mailing address:
  • Phone: 208-695-8342
  • Fax: 208-642-1315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP2282
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14060
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: