Provider Demographics
NPI:1679306237
Name:VAUGHN, GLADYS M (SLP)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:M
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 BRUNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5527
Mailing Address - Country:US
Mailing Address - Phone:843-621-3576
Mailing Address - Fax:
Practice Address - Street 1:157 HOME AVE
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-7625
Practice Address - Country:US
Practice Address - Phone:843-393-2867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7708235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist