Provider Demographics
NPI:1124152665
Name:YOUNG, MICHELLE CAROLE (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:CAROLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 BRUSHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4954
Mailing Address - Country:US
Mailing Address - Phone:407-928-7745
Mailing Address - Fax:
Practice Address - Street 1:140 N ORLANDO AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3606
Practice Address - Country:US
Practice Address - Phone:407-622-7177
Practice Address - Fax:407-628-8382
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4095235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist