Provider Demographics
NPI:1285032391
Name:VAUGHN, GARY (HIS;HAD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:HIS;HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-2867
Mailing Address - Country:US
Mailing Address - Phone:406-761-2716
Mailing Address - Fax:406-771-7619
Practice Address - Street 1:2122 10TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2867
Practice Address - Country:US
Practice Address - Phone:406-761-2716
Practice Address - Fax:406-771-7619
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1025237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist