Provider Demographics
NPI:1174744973
Name:VAUGHN, MARYKATE (MA-CCC-A)
Entity type:Individual
Prefix:
First Name:MARYKATE
Middle Name:
Last Name:VAUGHN
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 1:121 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2129
Mailing Address - Country:US
Mailing Address - Phone:908-232-2900
Mailing Address - Fax:
Practice Address - Street 1:140 PARK AVE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932
Practice Address - Country:US
Practice Address - Phone:973-404-9890
Practice Address - Fax:855-247-9816
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00034000231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ202093PB2Medicare ID - Type Unspecified