Healthcare Provider Details

I. General information

NPI: 1801157961
Provider Name (Legal Business Name): KRISTINE YOUNG SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4922 LASALLE RD BUILDING-B
HYATTSVILLE MD
20782-3302
US

IV. Provider business mailing address

3400 LAKESIDE VIEW DR
FALLS CHURCH VA
22041-2448
US

V. Phone/Fax

Practice location:
  • Phone: 301-864-2333
  • Fax: 877-828-2060
Mailing address:
  • Phone: 714-743-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number06581
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: