Provider Demographics
NPI:1750475844
Name:VAUGHAN, KATHRYN (KATY) GHOLSON (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN (KATY)
Middle Name:GHOLSON
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:VAUGHN
Other - Last Name:TINDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:DEPARTMENT OF OTOLARYNGOLOGY & COMMUNICATIVE SCIENCES
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-984-2938
Mailing Address - Fax:601-815-9774
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:DEPARTMENT OF OTOLARYNGOLOGY & COMMUNICATIVE SCIENCES
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-984-2938
Practice Address - Fax:601-815-9774
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3112235Z00000X
MS12135501235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist