Provider Demographics
NPI:1366296691
Name:YOUNG, KAYLEN ELISE
Entity type:Individual
Prefix:
First Name:KAYLEN
Middle Name:ELISE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLEN
Other - Middle Name:
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:23 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1941
Mailing Address - Country:US
Mailing Address - Phone:270-452-2835
Mailing Address - Fax:
Practice Address - Street 1:23 W CENTER ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1941
Practice Address - Country:US
Practice Address - Phone:270-452-2835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-05-03
Deactivation Date:2024-04-16
Deactivation Code:
Reactivation Date:2024-05-03
Provider Licenses
StateLicense IDTaxonomies
KY291627235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist