Healthcare Provider Details

I. General information

NPI: 1720863020
Provider Name (Legal Business Name): AVALON VAUGHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 CORONA RD
COLUMBIA MO
65203-5936
US

IV. Provider business mailing address

411 NOLKER DR
LAWSON MO
64062-8386
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-8783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2026023062
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: