MEDICARE: MRS. LEANN YOUNG M.S., CF-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
1	235Z00000X	Speech-Language Pathologist	TSLP2282	ID
2	235Z00000X	Speech-Language Pathologist	14060	OR

General Provider Information

NPI Number	:	1518201003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEANN YOUNG M.S., CF-SLP

Provider Business Mailing Address
First Line	:	1017 W ASHBY DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-6055
Country	:	US
Telephone Number	:	208-695-8342
Fax Number	:	208-642-1315

Provider Business Practice Location Address
First Line	:	1019 3RD AVE S
Second Line	:
City	:	PAYETTE
State	:	ID
Zip	:	83661-2832
Country	:	US
Telephone Number	:	208-642-4455
Fax Number	:	208-642-1315

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

Provider Enumeration Date	:	11/21/2012
Last Update Date	:	11/21/2012

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Directions to “ MRS. LEANN YOUNG M.S., CF-SLP” Practice Location

Language	Start Address	Practice Location

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