Individual
ELLEN VAUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
201 N ROSE AVE RM 4054, BLOOMINGTON, IN 47405-1005
(812) 856-8243
Mailing address
201 N ROSE AVE RM 4054, BLOOMINGTON, IN 47405-1005
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20042713A
IN
Other
Enumeration date
07/09/2020
Last updated
07/09/2020
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