Doctor Name: | MS. MARISSA RAE YOUNG |
NPI Number: | 1003243312 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLPA |
License Number: | SI2224 |
Business Practice Address: | 1681 Sw Buffum Ln Port St Lucie, FL - 349843529 |
Business Phone Number: | 5617296160 |
Business Fax Number: | |
Mailing Address: | 1681 Sw Buffum Ln, PORT ST LUCIE |
State: | FL |
Postal Code: | 349843529 |
Phone Number: | 5617296160 |
Fax Number: | |
NPI Enumeration Date: | 10/01/2013 |
NPI Last Update Date: | 10/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SI2224 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |