Provider Demographics
NPI:1730350026
Name:VAUGHAN, LINDA SUSAN (MA, CCC-A)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BLANCA AVENUE
Mailing Address - Street 2:ENT CLINIC
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101
Mailing Address - Country:US
Mailing Address - Phone:719-589-8025
Mailing Address - Fax:719-589-8087
Practice Address - Street 1:106 BLANCA AVENUE
Practice Address - Street 2:ENT DEPARTMENT
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101
Practice Address - Country:US
Practice Address - Phone:719-589-8025
Practice Address - Fax:719-589-8087
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01093231H00000X
CO602231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist