Provider Demographics
NPI:1699410837
Name:YOUNG, ANDREA KAY (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:KAY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 S 2000 W
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:UT
Mailing Address - Zip Code:84624-7900
Mailing Address - Country:US
Mailing Address - Phone:775-622-7488
Mailing Address - Fax:
Practice Address - Street 1:1237 S 2000 W
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:UT
Practice Address - Zip Code:84624-7900
Practice Address - Country:US
Practice Address - Phone:775-622-7488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12252688-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty