Provider Demographics
NPI:1669847570
Name:VAUGHAN, KATHLEEN (MS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 E ASH ST
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61529-9510
Mailing Address - Country:US
Mailing Address - Phone:309-696-4428
Mailing Address - Fax:
Practice Address - Street 1:9611 S HANNA CITY GLASFORD RD
Practice Address - Street 2:
Practice Address - City:GLASFORD
Practice Address - State:IL
Practice Address - Zip Code:61533-9506
Practice Address - Country:US
Practice Address - Phone:309-389-5025
Practice Address - Fax:309-389-5027
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008744235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist