Provider Demographics
NPI:1396014510
Name:YOUNG, JESSICA M (MS/SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 WOOD BROTHERS DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-1406
Mailing Address - Country:US
Mailing Address - Phone:276-694-4488
Mailing Address - Fax:
Practice Address - Street 1:4423 MOOREFIELD STORE RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-4729
Practice Address - Country:US
Practice Address - Phone:276-692-6882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist