Provider Demographics
NPI:1598957995
Name:VAUGHN, LINDA JOYCE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JOYCE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-4934
Mailing Address - Country:US
Mailing Address - Phone:301-848-3216
Mailing Address - Fax:
Practice Address - Street 1:4205 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-4934
Practice Address - Country:US
Practice Address - Phone:301-848-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005960235Z00000X
MD01959235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist