Provider Demographics
NPI:1326347121
Name:VAUGHN, BONNIE T (RHD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:T
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:RHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-1930
Mailing Address - Country:US
Mailing Address - Phone:618-201-1790
Mailing Address - Fax:618-549-0132
Practice Address - Street 1:2135 W RAMADA LN
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5326
Practice Address - Country:US
Practice Address - Phone:618-457-3318
Practice Address - Fax:618-549-0132
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional