Healthcare Provider Details

I. General information

NPI: 1659206100
Provider Name (Legal Business Name): ZACHARY M YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CLINTON ST
MAUMEE OH
43537-2811
US

IV. Provider business mailing address

111 CLINTON ST
MAUMEE OH
43537-2811
US

V. Phone/Fax

Practice location:
  • Phone: 419-740-3022
  • Fax:
Mailing address:
  • Phone: 419-740-3022
  • Fax: 419-740-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCAPRE.196010
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: