Provider Demographics
NPI:1902536378
Name:YOUNG, NANYA ROSINA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NANYA
Middle Name:ROSINA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:DE LEON
Mailing Address - State:TX
Mailing Address - Zip Code:76444-1947
Mailing Address - Country:US
Mailing Address - Phone:254-839-2130
Mailing Address - Fax:
Practice Address - Street 1:425 S TEXAS ST
Practice Address - Street 2:
Practice Address - City:DE LEON
Practice Address - State:TX
Practice Address - Zip Code:76444-1947
Practice Address - Country:US
Practice Address - Phone:254-839-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist