Provider Demographics
NPI:1306136999
Name:YOUNG, EILEEN (MSED, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSED, CCC-SLP
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:LOMBARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:49 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3010
Mailing Address - Country:US
Mailing Address - Phone:516-313-8321
Mailing Address - Fax:
Practice Address - Street 1:49 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3010
Practice Address - Country:US
Practice Address - Phone:516-313-8321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018082235Z00000X
CA14257235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist