Healthcare Provider Details

I. General information

NPI: 1063316941
Provider Name (Legal Business Name): ELLIE S YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HILYARD ST
EUGENE OR
97401-8122
US

IV. Provider business mailing address

5959 AVALON ST
EUGENE OR
97402-7572
US

V. Phone/Fax

Practice location:
  • Phone: 541-913-3020
  • Fax:
Mailing address:
  • Phone: 541-913-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number950-060-950-060-0160
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: