Provider Demographics
NPI:1588691380
Name:YOUNG, ALAN (AUD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5642 S 900 E
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1060
Mailing Address - Country:US
Mailing Address - Phone:801-713-0101
Mailing Address - Fax:801-262-1091
Practice Address - Street 1:5642 S 900 E
Practice Address - Street 2:SUITE 1
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1060
Practice Address - Country:US
Practice Address - Phone:801-713-0101
Practice Address - Fax:801-262-1091
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT348193-4101231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT80608OtherPEHP
UT97348193400001OtherREGENCE BCBS
UT00001812916-03OtherUNITED HEALTHCARE
UT212953OtherALTIUS
UT0900563310OtherMOLINA
UT1588691380Medicaid
UT1704142OtherCIGNA
UT00001812916-03OtherUNITED HEALTHCARE
UT80608OtherPEHP