Provider Demographics
NPI:1215173463
Name:YOUNG, PAULINE ELIZABETH (MACCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PAULINE
Middle Name:ELIZABETH
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3296 COUNTY HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-8967
Mailing Address - Country:US
Mailing Address - Phone:315-536-3573
Mailing Address - Fax:315-536-3573
Practice Address - Street 1:3296 COUNTY HOUSE RD
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-8967
Practice Address - Country:US
Practice Address - Phone:315-536-3573
Practice Address - Fax:315-536-3573
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008776-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist