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NPI Code Detail

MEDICARE: MS. MARISSA RAE YOUNG SLP

MEDICARE: MS. MARISSA RAE YOUNG SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSI2224FL
2235Z00000XSpeech-Language PathologistSZ9191FL
3235Z00000XSpeech-Language PathologistSA18025FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003243312
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARISSA RAE YOUNG SLP
Provider Business Mailing Address
First Line : 541 SW FIELDS AVE
Second Line :
City : PORT ST LUCIE
State : FL
Zip : 34953-4006
Country : US
Telephone Number : 561-729-6160
Fax Number :
Provider Business Practice Location Address
First Line : 4715 KIRBY LOOP RD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34981-5345
Country : US
Telephone Number : 772-577-6964
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2013
Last Update Date : 08/06/2021

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Directions to “ MS. MARISSA RAE YOUNG SLP” Practice Location

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