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NPI Code Detail

MEDICARE: CORNELIUS ANTOINE YOUNG JR.

MEDICARE: CORNELIUS ANTOINE YOUNG JR.
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
1106S00000XBehavior TechnicianWI

General Provider Information

NPI Number : 1770414864
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORNELIUS ANTOINE YOUNG JR.
Provider Business Mailing Address
First Line : 7119 NASHOTA CT
Second Line :
City : MEQUON
State : WI
Zip : 53092-8508
Country : US
Telephone Number : 888-754-0398
Fax Number :
Provider Business Practice Location Address
First Line : 6140 W EXECUTIVE DR STE B
Second Line :
City : MEQUON
State : WI
Zip : 53092-4499
Country : US
Telephone Number : 888-754-0398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

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