Provider Demographics
NPI:1326658527
Name:VAUGHN, DANIELLE ROSE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ROSE
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 1:4251 BOTANICAL AVE APT B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3520
Mailing Address - Country:US
Mailing Address - Phone:636-232-1144
Mailing Address - Fax:
Practice Address - Street 1:4251 BOTANICAL AVE APT B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-3520
Practice Address - Country:US
Practice Address - Phone:636-232-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician