MEDICARE: RACHEL VAUGHN PSYD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1013598747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RACHEL VAUGHN PSYD LLC

Provider Business Mailing Address
First Line	:	111 NORTH WABASH AVE
Second Line	:	MAILBOX 1410
City	:	CHICAGO
State	:	IL
Zip	:	60602
Country	:	US
Telephone Number	:	312-860-2309
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 E 14TH ST APT 710
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2980
Country	:	US
Telephone Number	:	312-860-2309
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	RACHEL VAUGHN
Credential	:	PSYD
Telephone Number	:	312-860-2309

Provider Enumeration Date	:	04/15/2021
Last Update Date	:	04/15/2021

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