Provider Demographics
NPI:1457236283
Name:YOUNG, AUDREY LAUREN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:LAUREN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MO
Mailing Address - Zip Code:64660-8122
Mailing Address - Country:US
Mailing Address - Phone:660-998-0279
Mailing Address - Fax:
Practice Address - Street 1:18475 HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MO
Practice Address - Zip Code:64660-9120
Practice Address - Country:US
Practice Address - Phone:660-675-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist