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General NPI Number Information
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NPI Number | 1568185528
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Entity Type | Individual
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Provider Name | MISS JESSICA ALLISON YOUNG
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Gender | Female
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 1825 COMMERCE CENTER BLVD
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City | FAIRBORN
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State | OH
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Zip | 45324-6336
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Country | US
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Telephone | 937-376-8755
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Fax |
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Provider Business Mailing Address
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Address Line | 526 MONTERAY AVE
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City | KETTERING
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State | OH
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Zip | 45419-2253
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Country | US
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Telephone | 937-900-4142
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.181671
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License Number State | OH
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