Healthcare Provider Details

I. General information

NPI: 1932038403
Provider Name (Legal Business Name): SHANNON ELIZABETH YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6781 N TOWNE RD
DEFOREST WI
53532-2546
US

IV. Provider business mailing address

125 E HOLUM ST APT 207
DEFOREST WI
53532-1175
US

V. Phone/Fax

Practice location:
  • Phone: 608-842-6165
  • Fax:
Mailing address:
  • Phone: 715-571-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1001374416
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: