MEDICARE: AVALON 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	235Z00000X	Speech-Language Pathologist	2026023062	MO

General Provider Information

NPI Number	:	1720863020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVALON VAUGHN

Provider Business Mailing Address
First Line	:	411 NOLKER DR
Second Line	:
City	:	LAWSON
State	:	MO
Zip	:	64062-8386
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1906 CORONA RD
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5936
Country	:	US
Telephone Number	:	573-777-8783
Fax Number	:

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

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	06/02/2026

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Directions to “ AVALON VAUGHN ” Practice Location

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