Provider Demographics
NPI:1609290691
Name:JENNIFER VAUGHN THERAPY SERVICES
Entity Type:Organization
Organization Name:JENNIFER VAUGHN THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-851-5484
Mailing Address - Street 1:25282 HAZELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-2797
Mailing Address - Country:US
Mailing Address - Phone:218-851-5484
Mailing Address - Fax:
Practice Address - Street 1:25282 HAZELWOOD DR
Practice Address - Street 2:
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468-2797
Practice Address - Country:US
Practice Address - Phone:218-851-5484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2090251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710260708OtherNPI INDIVIDUAL NUMBER