Basic Information
| Provider Information | |||||||||
| NPI: | 1669679890 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | ADRIENNE | ||||||||
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| NameSuffix: | SR. | ||||||||
| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 GRAND CENTRAL AVE | ||||||||
| Address2: | STE 101 | ||||||||
| City: | VIENNA | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261051079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046932781 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457502024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403733597 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 11/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 8415 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.