Provider Demographics
NPI:1619426731
Name:VAUGHN, NICOLE LEANNE (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:LEANNE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 LONESOME OAK LN
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37860-9370
Mailing Address - Country:US
Mailing Address - Phone:423-736-9923
Mailing Address - Fax:
Practice Address - Street 1:1440 LONESOME OAK LN
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:TN
Practice Address - Zip Code:37860-9370
Practice Address - Country:US
Practice Address - Phone:423-736-9923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4850235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist