Healthcare Provider Details

I. General information

NPI: 1134049968
Provider Name (Legal Business Name): SYDNI VAUGHAN NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 SE ALDER ST STE 301
PORTLAND OR
97214-2400
US

IV. Provider business mailing address

15920 NE 48TH CIR
VANCOUVER WA
98682-5208
US

V. Phone/Fax

Practice location:
  • Phone: 503-567-8510
  • Fax:
Mailing address:
  • Phone: 503-567-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR9652
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberR9652
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: