Healthcare Provider Details

I. General information

NPI: 1124965421
Provider Name (Legal Business Name): JIL LAYNE VAUGHN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 PATRIOT LANE
BEAVER CREEK MN
56116
US

IV. Provider business mailing address

510 31ST ST
HILLS MN
56138-4028
US

V. Phone/Fax

Practice location:
  • Phone: 507-673-2541
  • Fax:
Mailing address:
  • Phone: 605-759-2421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12008261
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: