Marissa Rae Young, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA18025 Issued in FL

Practice address

4715 Kirby Loop Rd
Fort Pierce, FL 34981-5345

Phone

(772) 577-6964

NPI assigned

Oct 1, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grace Therapies, LLC

  • Clinic/Center
  • Fort Pierce, FL
  • NPI 1194030155

  Speech-Language Pathologist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628208000000",
    "number": "1003243312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 SW FIELDS AVE",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349534006",
            "telephone_number": "561-729-6160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4715 KIRBY LOOP RD",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349815345",
            "telephone_number": "772-577-6964"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1681 SW Buffum Ln",
            "address_purpose": "LOCATION",
            "city": "Port St Lucie",
            "state": "FL",
            "postal_code": "349843529",
            "country_code": "US",
            "telephone_number": "561-729-6160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "MARISSA",
        "middle_name": "RAE",
        "name_prefix": "Ms.",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-01",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SI2224",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SZ9191",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA18025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103979600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret Wynter
• Ravi Xavier, MD
• Y&G ABA Services LLC
• Wai Fung Yeo, PHARMD
• Selina Yossef
• Your Royal Care LLC
• Mark Youssef, RPH
• Youth & Family Behavioral Health Center, Inc.
• Youth & Family Behavioral Health Center, Inc.
• David Zaboli, M.D.

• Speech-Language Pathologist in Fort Pierce, FL
• Providers in Fort Pierce, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.