Provider Demographics
NPI:1417705021
Name:VAUGHN, HOLLY M (SLP)
Entity type:Individual
Prefix:
First Name:HOLLY
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 1:241 CHESTERTON WAY APT 1
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4570
Mailing Address - Country:US
Mailing Address - Phone:336-270-1119
Mailing Address - Fax:
Practice Address - Street 1:1305 W WENDOVER AVE STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8100
Practice Address - Country:US
Practice Address - Phone:336-541-8167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30002820235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist