Healthcare Provider Details

I. General information

NPI: 1730350026
Provider Name (Legal Business Name): LINDA SUSAN VAUGHAN M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 12/21/2025
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 BLANCA AVENUE ENT DEPARTMENT
ALAMOSA CO
81101
US

IV. Provider business mailing address

106 BLANCA AVENUE ENT CLINIC
ALAMOSA CO
81101
US

V. Phone/Fax

Practice location:
  • Phone: 719-589-8025
  • Fax: 719-589-8087
Mailing address:
  • Phone: 719-589-8025
  • Fax: 719-589-8087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01093
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number602
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: