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General NPI Number Information
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NPI Number | 1932038403
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Entity Type | Individual
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Provider Name | SHANNON ELIZABETH YOUNG
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Gender | Female
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Dates
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Enumeration Date | 05/19/2026
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Last Update Date | 05/19/2026
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Provider Practice Location Address
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Address Line | 6781 N TOWNE RD
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City | DEFOREST
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State | WI
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Zip | 53532-2546
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Country | US
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Telephone | 608-842-6165
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Fax |
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Provider Business Mailing Address
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Address Line | 125 E HOLUM ST APT 207
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City | DEFOREST
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State | WI
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Zip | 53532-1175
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Country | US
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Telephone | 715-571-0447
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1001374416
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License Number State | WI
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