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NPI Code Detail

MEDICARE: EDITH ANN YOUNG MA CCC SLP

MEDICARE: EDITH ANN YOUNG MA CCC 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 Pathologist12875TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17822OTHERTXPARKLAND HEALTHPLAN CHIP
27879125OTHERTXAETNA PPO
3528410OTHERTXBLUE CROSS BLUE SHIELD
42367715OTHERTXAETNA HMO

General Provider Information

NPI Number : 1366534380
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDITH ANN YOUNG MA CCC SLP
Provider Business Mailing Address
First Line : 13508 BORGATA LN
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73170-2056
Country : US
Telephone Number : 214-415-1756
Fax Number :
Provider Business Practice Location Address
First Line : 9900 BROADWAY EXT STE 200
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-6323
Country : US
Telephone Number : 972-937-8255
Fax Number : 972-937-8504
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 11/27/2018

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Directions to “ EDITH ANN YOUNG MA CCC SLP” Practice Location

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