Provider Demographics
NPI:1912799701
Name:YOUNG, JACQUELINE CLAUDIA (PHT, CCMA,)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CLAUDIA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHT, CCMA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 RABORN RD
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-4947
Mailing Address - Country:US
Mailing Address - Phone:706-831-2065
Mailing Address - Fax:
Practice Address - Street 1:2760 RABORN RD
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-4947
Practice Address - Country:US
Practice Address - Phone:706-831-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10210250235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist