Healthcare Provider Details

I. General information

NPI: 1164081097
Provider Name (Legal Business Name): Z HAVEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIONNA MARIE VAUGHN

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 SE 12TH AVE
PORTLAND OR
97214-1323
US

IV. Provider business mailing address

1931 NW 29TH AVE APT 12
PORTLAND OR
97210-2280
US

V. Phone/Fax

Practice location:
  • Phone: 971-359-0012
  • Fax:
Mailing address:
  • Phone: 971-263-5372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29529
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: