Healthcare Provider Details

I. General information

NPI: 1912907007
Provider Name (Legal Business Name): CAROLYN VIRGINIA YOUNG M.A., CCC-A, FAAA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 CHURCH ST 420
EVANSTON IL
60201-4508
US

IV. Provider business mailing address

636 CHURCH ST 420
EVANSTON IL
60201-4508
US

V. Phone/Fax

Practice location:
  • Phone: 847-869-9433
  • Fax:
Mailing address:
  • Phone: 847-869-9433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: