Healthcare Provider Details

I. General information

NPI: 1508776550
Provider Name (Legal Business Name): CONNIE SYMONE YOUNG COS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

786 MCCOOL RD STE 7
VALPARAISO IN
46385-8894
US

IV. Provider business mailing address

786 MCCOOL RD STE 7
VALPARAISO IN
46385-8894
US

V. Phone/Fax

Practice location:
  • Phone: 219-308-0141
  • Fax:
Mailing address:
  • Phone: 219-308-0141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberBC21500013
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: