MEDICARE: KENNETH A VAUGHN JR. RC CADC I CRM QMHA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	08-06-73	OR
2	101Y00000X	Counselor	RC00052879	WA
3	171M00000X	Case Manager/Care Coordinator	QMHA	OR

General Provider Information

NPI Number	:	1164582896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH A VAUGHN JR. RC CADC I CRM QMHA

Provider Business Mailing Address
First Line	:	3325 HAROLD DR NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1339
Country	:	US
Telephone Number	:	503-363-2021
Fax Number	:	503-363-4820

Provider Business Practice Location Address
First Line	:	3325 HAROLD DR NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1339
Country	:	US
Telephone Number	:	503-363-2021
Fax Number	:	503-363-4820

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	11/16/2012

Similar Medicare Providers

1679520787 — CASCADIA BEHAVIORAL HEALTHCARE INC
Practice Location Address:

3325 HAROLD DR NE
SALEM, OR
97305-1339

Practice Phone: 503-238-0769
Practice Fax: 503-889-2599

1083760359 — MS. FRANCES NADINE MCKENNA CADCI
Practice Location Address:

3325 HAROLD DR NE
SALEM, OR
97305-1339

Practice Phone: 503-363-2021
Practice Fax: 503-363-4820

1255487526 — MS. KIM I HAEG BS
Practice Location Address:

3325 HAROLD DR NE
SALEM, OR
97305-1339

Practice Phone: 503-363-2021
Practice Fax:

1376689216 — MR. DONNIE RAY TOQUERO
Practice Location Address:

3321 HAROLD DR NE
SALEM, OR
97305-1339

Practice Phone: 503-399-5597
Practice Fax: 503-316-9740

1154467017 — MRS. CHRISTINA JEAN STAMBAUGH
Practice Location Address:

3321 HAROLD DR NE
SALEM, OR
97305-1339

Practice Phone: 503-399-5597
Practice Fax:

1497891451 — MS. DEBORAH NICOLETTE HALL CADC
Practice Location Address:

3325 HAROLD DR NE
SALEM, OR
97305-1339

Practice Phone: 503-363-2021
Practice Fax:

Directions to “ KENNETH A VAUGHN JR. RC CADC I CRM QMHA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.