Healthcare Provider Details

I. General information

NPI: 1730004532
Provider Name (Legal Business Name): REBECCA ANN YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 4TH ST
MOOSE LAKE MN
55767-7722
US

IV. Provider business mailing address

205 4TH ST
MOOSE LAKE MN
55767-7722
US

V. Phone/Fax

Practice location:
  • Phone: 218-491-3744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberDOUL-431
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: