Healthcare Provider Details

I. General information

NPI: 1154007318
Provider Name (Legal Business Name): KATHRYN YOUNG AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CHARLOIS BLVD
WINSTON SALEM NC
27103-1522
US

IV. Provider business mailing address

255 BELLEFORDE CT
LEWISVILLE NC
27023-8304
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-3361
  • Fax:
Mailing address:
  • Phone: 336-661-5424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number30001952
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: