Provider Demographics
NPI:1295189231
Name:VAUGHAN, KATELYN
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:VAUGHAN
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 1:10702 CRESTDALE LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-3624
Mailing Address - Country:US
Mailing Address - Phone:870-338-0579
Mailing Address - Fax:
Practice Address - Street 1:10310 W MARKHAM ST STE 205
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1579
Practice Address - Country:US
Practice Address - Phone:501-406-7910
Practice Address - Fax:501-251-1099
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3917235Z00000X
AR4154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist