Provider Demographics
NPI:1780701516
Name:VAUGHAN, JERRILYN FRASIER (AUD, L-SLP/A)
Entity type:Individual
Prefix:DR
First Name:JERRILYN
Middle Name:FRASIER
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:AUD, L-SLP/A
Other - Prefix:
Other - First Name:JERRILYN
Other - Middle Name:COOK
Other - Last Name:FRAISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1503 GOODWIN RD STE 205
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2938
Mailing Address - Country:US
Mailing Address - Phone:318-251-1572
Mailing Address - Fax:318-251-1572
Practice Address - Street 1:1503 GOODWIN RD STE 205
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270
Practice Address - Country:US
Practice Address - Phone:318-251-1572
Practice Address - Fax:318-251-1572
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4487231H00000X, 231HA2400X, 231HA2500X, 235Z00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist