Provider Demographics
NPI:1760468458
Name:VAUGHT, VICKI (LMP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:VAUGHT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 N NORMANDIE ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-5118
Mailing Address - Country:US
Mailing Address - Phone:509-326-3795
Mailing Address - Fax:509-325-7418
Practice Address - Street 1:3809 N MONROE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2853
Practice Address - Country:US
Practice Address - Phone:509-326-3795
Practice Address - Fax:509-325-7418
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019025225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00019025OtherSTATE LICENSE