Provider Demographics
NPI:1811747595
Name:VAUGHN, SENECA RAE (DACM, LAC)
Entity type:Individual
Prefix:
First Name:SENECA
Middle Name:RAE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 SAINT JAMES CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2126
Mailing Address - Country:US
Mailing Address - Phone:502-475-2836
Mailing Address - Fax:
Practice Address - Street 1:501 BAXTER AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1103
Practice Address - Country:US
Practice Address - Phone:502-632-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTAC148171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist