Provider Demographics
NPI:1659627552
Name:HUEBNER-VAUGHAN, PATTY S (LISW)
Entity Type:Individual
Prefix:MS
First Name:PATTY
Middle Name:S
Last Name:HUEBNER-VAUGHAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W BURLINGTON
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-3242
Mailing Address - Country:US
Mailing Address - Phone:319-470-4407
Mailing Address - Fax:
Practice Address - Street 1:823 N 6TH ST STE2
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-5229
Practice Address - Country:US
Practice Address - Phone:319-237-1732
Practice Address - Fax:319-237-1746
Is Sole Proprietor?:No
Enumeration Date:2012-07-28
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA95055101YA0400X
IA0080821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)