Provider Demographics
NPI:1710559661
Name:VAUGHN, KATERI ROSE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:KATERI
Middle Name:ROSE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-2855
Mailing Address - Country:US
Mailing Address - Phone:618-980-6711
Mailing Address - Fax:
Practice Address - Street 1:2209 MILLS AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-2855
Practice Address - Country:US
Practice Address - Phone:618-980-6711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist