MEDICARE: JENAE VAUGHN

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	101YM0800X	Mental Health Counselor	180.017575	IL

General Provider Information

NPI Number	:	1184582777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENAE VAUGHN

Provider Business Mailing Address
First Line	:	16000 VAN DRUNEN RD STE 8
Second Line	:
City	:	SOUTH HOLLAND
State	:	IL
Zip	:	60473-1242
Country	:	US
Telephone Number	:	708-637-6760
Fax Number	:

Provider Business Practice Location Address
First Line	:	16000 VAN DRUNEN RD STE 8
Second Line	:
City	:	SOUTH HOLLAND
State	:	IL
Zip	:	60473-1242
Country	:	US
Telephone Number	:	708-637-6760
Fax Number	:

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “ JENAE VAUGHN ” Practice Location

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