Provider Demographics
NPI:1053097832
Name:YOUNG, AUDREY
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 BEAR CREEK DRIVE APT 503
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146
Mailing Address - Country:US
Mailing Address - Phone:216-313-4027
Mailing Address - Fax:
Practice Address - Street 1:25701 N LAKELAND BLVD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132
Practice Address - Country:US
Practice Address - Phone:216-273-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator