Provider Information for 1679520951
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Mrs. JORRENE MELBA VAUGHN L.M.S.W.
Sex: Female
NPI: 1679520951
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1679520951 | ||||||||
| Enumeration Date | 2006-05-30 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2494 HIGHRIDGE LN SE GRAND RAPIDS, MI 49546-7536 United States Phone: 616-726-2739 | Fax: | ||||||||
| Primary Practice Address | 2494 HIGHRIDGE LN SE GRAND RAPIDS, MI 49546-7536 United States Phone: 616-726-2739 | Fax: | ||||||||
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