Individual
RICHARD IVAN VAUGHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS
Contact information
Practice address
4310 NE KILLINGSWORTH ST, PORTLAND, OR 97208-3007
(503) 535-1150
Mailing address
PO BOX 3007, 4310 NE KILLINGSWORTH ST, PORTLAND, OR 97208-3007
(503) 535-1150
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
07/15/2013
Last updated
07/15/2013
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