MEDICARE: AMANDA JOLEEN YOUNG

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
1	235Z00000X	Speech-Language Pathologist	2935-154	WI

General Provider Information

NPI Number	:	1144150467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JOLEEN YOUNG

Provider Business Mailing Address
First Line	:	208 E SOUTH ST
Second Line	:
City	:	LAKE GENEVA
State	:	WI
Zip	:	53147-2436
Country	:	US
Telephone Number	:	262-348-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 E SOUTH ST
Second Line	:
City	:	LAKE GENEVA
State	:	WI
Zip	:	53147-2436
Country	:	US
Telephone Number	:	262-348-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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Directions to “ AMANDA JOLEEN YOUNG ” Practice Location

Language	Start Address	Practice Location

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