Provider Demographics
NPI:1366534380
Name:YOUNG, EDITH ANN (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:ANN
Other - Last Name:MCCOLLOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC SLP
Mailing Address - Street 1:13508 BORGATA LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-2056
Mailing Address - Country:US
Mailing Address - Phone:214-415-1756
Mailing Address - Fax:
Practice Address - Street 1:9900 BROADWAY EXT STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-6323
Practice Address - Country:US
Practice Address - Phone:972-937-8255
Practice Address - Fax:972-937-8504
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12875235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7822OtherPARKLAND HEALTHPLAN CHIP
TX7879125OtherAETNA PPO
TX528410OtherBLUE CROSS BLUE SHIELD
TX2367715OtherAETNA HMO