Provider Demographics
NPI:1083926166
Name:VAUGHN, SHANNON MCKALA
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MCKALA
Last Name:VAUGHN
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 1:1486 BAILEE WAY SW
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-3318
Mailing Address - Country:US
Mailing Address - Phone:256-490-6980
Mailing Address - Fax:
Practice Address - Street 1:1486 BAILEE WAY SW
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3318
Practice Address - Country:US
Practice Address - Phone:256-490-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3068235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist