Healthcare Provider Details

I. General information

NPI: 1659235422
Provider Name (Legal Business Name): DEBORAH A DE VAUGHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 E 71ST PL APT 1
CHICAGO IL
60619-0034
US

IV. Provider business mailing address

1519 E 71ST PL APT 1
CHICAGO IL
60619-0034
US

V. Phone/Fax

Practice location:
  • Phone: 773-914-8246
  • Fax:
Mailing address:
  • Phone: 773-914-8246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: