MEDICARE: DR. CAEDY JANAE YOUNG PH.D.

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	103T00000X	Psychologist	3704	OR
2	101YM0800X	Mental Health Counselor

Other Identifiers

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

General Provider Information

NPI Number	:	1215395751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAEDY JANAE YOUNG PH.D.

Provider Business Mailing Address
First Line	:	9600 SW OAK ST STE 500&520
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-6583
Country	:	US
Telephone Number	:	971-364-8069
Fax Number	:

Provider Business Practice Location Address
First Line	:	9600 SW OAK ST STE 500&520
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-6583
Country	:	US
Telephone Number	:	971-364-8069
Fax Number	:

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

Provider Enumeration Date	:	01/28/2016
Last Update Date	:	10/27/2023

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