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Individual

PAT VAUGHN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS.ED., LCPC

Contact information

Practice address
4875 MANHATTAN DR, ROCKFORD, IL 61108-2265
(815) 227-4673
Mailing address
4875 MANHATTAN DR, ROCKFORD, IL 61108-2265
(815) 227-4673

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10121306
BLUE CROSS BLUE SHIELD
IL
01
209286
VALUE OPTIONS
IL
Enumeration date
03/02/2007
Last updated
07/08/2007
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