Individual
EDITH ANN YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC SLP
Contact information
Practice address
9900 BROADWAY EXT STE 200, OKLAHOMA CITY, OK 73114-6323
(972) 937-8255
(972) 937-8504
Mailing address
13508 BORGATA LN, OKLAHOMA CITY, OK 73170-2056
(214) 415-1756
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12875
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2367715
AETNA HMO
TX
01
—
528410
BLUE CROSS BLUE SHIELD
TX
01
—
7822
PARKLAND HEALTHPLAN CHIP
TX
01
—
7879125
AETNA PPO
TX
Enumeration date
09/28/2006
Last updated
11/27/2018
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