Provider Demographics
NPI:1972781482
Name:YOUNG, EMILY LYNN (RD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:LYNN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 MAUCK RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-8338
Mailing Address - Country:US
Mailing Address - Phone:517-439-2497
Mailing Address - Fax:517-279-5443
Practice Address - Street 1:4300 MAUCK RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-8338
Practice Address - Country:US
Practice Address - Phone:517-439-2497
Practice Address - Fax:517-279-5443
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI896021133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered