Healthcare Provider Details

I. General information

NPI: 1518882315
Provider Name (Legal Business Name): JENNIFER LEA YOUNG CPRS
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

34 CHITTENDEN AVE APT 22
COLUMBUS OH
43201-2159
US

IV. Provider business mailing address

34 CHITTENDEN AVE APT 22
COLUMBUS OH
43201-2159
US

V. Phone/Fax

Practice location:
  • Phone: 614-209-6238
  • Fax:
Mailing address:
  • Phone: 614-209-6238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.003254
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: