Provider Demographics
NPI:1902264914
Name:YOUNG, ANNA LAUREN (SLP)
Entity Type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:LAUREN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:LAUREN
Other - Last Name:THRASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7109 VININGS WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-9291
Mailing Address - Country:US
Mailing Address - Phone:334-538-3642
Mailing Address - Fax:
Practice Address - Street 1:705 17TH ST
Practice Address - Street 2:SUITE 407
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3500
Practice Address - Country:US
Practice Address - Phone:706-321-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009193235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist