Basic Information
| Provider Information | |||||||||
| NPI: | 1992968341 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAUGHN | ||||||||
| FirstName: | CHLOE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2410 SE 121ST AVE | ||||||||
| Address2: | SUITE 216 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972164066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033355975 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2410 SE 121ST AVE | ||||||||
| Address2: | SUITE 216 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972164066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033355975 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2008 | ||||||||
| LastUpdateDate: | 03/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | LW61035823 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.