MEDICARE: KATHLEEN VAUGHAN M.S.

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	146008744	IL

General Provider Information

NPI Number	:	1669847570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN VAUGHAN M.S.

Provider Business Mailing Address
First Line	:	529 E ASH ST
Second Line	:
City	:	ELMWOOD
State	:	IL
Zip	:	61529-9510
Country	:	US
Telephone Number	:	309-696-4428
Fax Number	:

Provider Business Practice Location Address
First Line	:	9611 S HANNA CITY GLASFORD RD
Second Line	:
City	:	GLASFORD
State	:	IL
Zip	:	61533-9506
Country	:	US
Telephone Number	:	309-389-5025
Fax Number	:	309-389-5027

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

Provider Enumeration Date	:	12/02/2015
Last Update Date	:	08/22/2019

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Directions to “ KATHLEEN VAUGHAN M.S.” Practice Location

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