Provider Demographics
NPI:1922288182
Name:VAUGHAN, STACIE M (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:M
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 CROSBY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-1901
Mailing Address - Country:US
Mailing Address - Phone:412-720-9571
Mailing Address - Fax:
Practice Address - Street 1:2685 CROSBY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-1901
Practice Address - Country:US
Practice Address - Phone:412-720-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1955280OtherHIGHMARK BLUESHIELD