MEDICARE: ERIKA VAUGHN MSW

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	1041C0700X	Clinical Social Worker	15426	MN

General Provider Information

NPI Number	:	1497121958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA VAUGHN MSW

Provider Business Mailing Address
First Line	:	435 PHALEN BLVD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55130-5302
Country	:	US
Telephone Number	:	651-325-2265
Fax Number	:	651-602-6891

Provider Business Practice Location Address
First Line	:	435 PHALEN BLVD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55130-5302
Country	:	US
Telephone Number	:	651-291-2848
Fax Number	:

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

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	12/01/2025

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