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NPI Code Detail

MEDICARE: JARROD VAUGHAN BCBA

MEDICARE: JARROD VAUGHAN BCBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1922663202
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARROD VAUGHAN BCBA
Provider Business Mailing Address
First Line : 621 QUEEN ST
Second Line :
City : PORTSMOUTH
State : VA
Zip : 23704-3727
Country : US
Telephone Number : 816-588-7163
Fax Number :
Provider Business Practice Location Address
First Line : 640 NORTH ST
Second Line :
City : PORTSMOUTH
State : VA
Zip : 23704-2415
Country : US
Telephone Number : 757-967-9926
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2019
Last Update Date : 06/21/2023

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