Basic Information
| Provider Information | |||||||||
| NPI: | 1649943705 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | KATELYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8059 S 1ST ST | ||||||||
| Address2: | |||||||||
| City: | MILAN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383586837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316952427 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14510 US-79 | ||||||||
| Address2: | |||||||||
| City: | MCKENZIE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7313525317 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2021 | ||||||||
| LastUpdateDate: | 07/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7105 | TN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.