Provider Demographics
NPI:1164823860
Name:VAUGHN, RACHAEL STONE
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:STONE
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 1:131 WAR ADMIRAL DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-3311
Mailing Address - Country:US
Mailing Address - Phone:803-542-2815
Mailing Address - Fax:
Practice Address - Street 1:2999 SUNSET BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3496
Practice Address - Country:US
Practice Address - Phone:803-553-1235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5592235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist