Provider Demographics
NPI:1750962700
Name:VAUGHAN, JORDAN TAYLOR (AUD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:TAYLOR
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:TAYLOR
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:4300 W. 7TH ST.
Mailing Address - Street 2:ATTN: 126/LR
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4832
Mailing Address - Country:US
Mailing Address - Phone:501-257-1085
Mailing Address - Fax:
Practice Address - Street 1:4300 W. 7TH ST.
Practice Address - Street 2:ATTN: 126/LR
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4832
Practice Address - Country:US
Practice Address - Phone:501-257-1085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AR201373231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR268518720Medicaid