Provider Demographics
NPI:1356866776
Name:VAUGHN, MATTHEW
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6741 NE 182ND ST UNIT C313
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-5011
Mailing Address - Country:US
Mailing Address - Phone:209-609-0476
Mailing Address - Fax:
Practice Address - Street 1:6741 NE 182ND ST
Practice Address - Street 2:UNIT C313
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028
Practice Address - Country:US
Practice Address - Phone:209-609-0476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1605086562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer