Provider Demographics
NPI:1285766147
Name:VAUGHT, PENNY ANNETTE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:ANNETTE
Last Name:VAUGHT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 THOUSAND OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-9273
Mailing Address - Country:US
Mailing Address - Phone:501-329-0875
Mailing Address - Fax:
Practice Address - Street 1:48 THOUSAND OAKS CIR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-9273
Practice Address - Country:US
Practice Address - Phone:501-329-0875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR990235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist