Provider Demographics
NPI:1538882626
Name:YOUNG, LEANNE BONNIE (RTC, CTRS)
Entity type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:BONNIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RTC, CTRS
Other - Prefix:MS
Other - First Name:LEANNE
Other - Middle Name:B
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RTC, CTRS
Mailing Address - Street 1:4150 CLEMENT ST BLDG 208
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1563
Mailing Address - Country:US
Mailing Address - Phone:415-221-4810
Mailing Address - Fax:
Practice Address - Street 1:4150 CLEMENT ST BLDG 208
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1563
Practice Address - Country:US
Practice Address - Phone:415-221-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2661-T225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist