MEDICARE: LINDA JOYCE VAUGHN MS, CCC-SLP

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	235Z00000X	Speech-Language Pathologist	SLP005960	GA
2	235Z00000X	Speech-Language Pathologist	01959	MD

General Provider Information

NPI Number	:	1598957995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA JOYCE VAUGHN MS, CCC-SLP

Provider Business Mailing Address
First Line	:	4205 LAKEVIEW DR
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-4934
Country	:	US
Telephone Number	:	301-848-3216
Fax Number	:

Provider Business Practice Location Address
First Line	:	4205 LAKEVIEW DR
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-4934
Country	:	US
Telephone Number	:	301-848-3216
Fax Number	:

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

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	04/30/2013

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