Individual
MRS. BRANDY DIANE YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.C.D.,CCC-SLP
Contact information
Practice address
221 LINDLEY LANE, NEWPORT, AR 72112
(870) 523-2124
Mailing address
111 YOUNG ST, TUCKERMAN, AR 72473-9327
(870) 349-3037
(870) 349-2104
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP1748
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12029538
ASHA PROVIDER NUMBER
AR
01
—
SP1748
STATE LICENSE NUMBER
AR
Enumeration date
11/28/2006
Last updated
07/09/2007
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