Healthcare Provider Details

I. General information

NPI: 1982846390
Provider Name (Legal Business Name): JENNIFER MARIE YOUNG AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 FOREST AVE STE 227
RICHMOND VA
23229-4933
US

IV. Provider business mailing address

7601 FOREST AVE STE 227
RICHMOND VA
23229-4933
US

V. Phone/Fax

Practice location:
  • Phone: 804-358-5851
  • Fax: 804-284-1278
Mailing address:
  • Phone: 804-358-5851
  • Fax: 804-284-1278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number030826
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5249
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1002
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: