Healthcare Provider Details

I. General information

NPI: 1417466350
Provider Name (Legal Business Name): MRS. PATTY KAY YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 2
ELIZABETHTOWN IL
62931
US

IV. Provider business mailing address

805 N MAIN ST
ANNA IL
62906-1628
US

V. Phone/Fax

Practice location:
  • Phone: 618-287-7601
  • Fax:
Mailing address:
  • Phone: 618-697-0377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: