Provider Demographics
NPI:1700248465
Name:JENNIFER VAUGHN THERAPY SERVICES
Entity type:Organization
Organization Name:JENNIFER VAUGHN THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:218-820-6626
Mailing Address - Street 1:985 MARLIN PL W
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PILLAGER
Mailing Address - State:MN
Mailing Address - Zip Code:56473-2516
Mailing Address - Country:US
Mailing Address - Phone:218-820-6626
Mailing Address - Fax:
Practice Address - Street 1:985 MARLIN PL W
Practice Address - Street 2:SUITE 3
Practice Address - City:PILLAGER
Practice Address - State:MN
Practice Address - Zip Code:56473-2516
Practice Address - Country:US
Practice Address - Phone:218-820-6626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2090OtherLICENSE