Provider Demographics
NPI:1689964629
Name:VAUGHN, KENDRA RENEE (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:RENEE
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 1:12457 TIMBERLAND BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5210
Mailing Address - Country:US
Mailing Address - Phone:817-602-9298
Mailing Address - Fax:
Practice Address - Street 1:12457 TIMBERLAND BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5210
Practice Address - Country:US
Practice Address - Phone:817-602-9298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18129235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist