Organization
VAUGHN R JEFFERSON PSYD MDIV LP LLC
Active
Organization
VAUGHN R JEFFERSON PSYD MDIV LP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VAUGHN ROBERT JEFFERSON PSYD (PRESIDENT)
(651) 483-1333
Entity
Organization
Contact information
Practice address
1030 WEST COUNTY ROAD E, STE 260, SHOREVIEW, MN 55126
(651) 483-1333
(651) 789-3088
Mailing address
1030 WEST COUNTY ROAD E, STE 260, SHOREVIEW, MN 55126
(651) 483-1333
(651) 789-3088
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP 1666
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
688750300
—
MN
Enumeration date
02/25/2009
Last updated
11/06/2014
Update your record
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