Provider Demographics
NPI:1467925230
Name:VAUGHT-RUDICH, REGINA LYNN (IADC)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:LYNN
Last Name:VAUGHT-RUDICH
Suffix:
Gender:F
Credentials:IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-2828
Mailing Address - Country:US
Mailing Address - Phone:515-249-8596
Mailing Address - Fax:855-631-0252
Practice Address - Street 1:601 FOREST AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2828
Practice Address - Country:US
Practice Address - Phone:515-249-8596
Practice Address - Fax:855-631-0252
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18002101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)