Provider Demographics
NPI:1861223562
Name:YOUNG, SHANNON L (HAS)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5178 CHILDRENS HOME BRADFORD RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-9327
Mailing Address - Country:US
Mailing Address - Phone:937-548-4242
Mailing Address - Fax:
Practice Address - Street 1:5178 CHILDRENS HOME BRADFORD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-9327
Practice Address - Country:US
Practice Address - Phone:937-548-4242
Practice Address - Fax:937-548-4562
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIL.03526237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist