Jefferson, Vaughn Robert

Jefferson, Vaughn Robert is an sole proprietor health care provider with primary practice located at 1030 West County Road E Ste 260, Shoreview MN 55126. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Jefferson, Vaughn Robert can be contacted via phone (651) 483-1333.

Contact Information

Primary practice address
1030 West County Road E Ste 260 Shoreview MN 55126
Phone: (651) 483-1333
Fax: (651) 789-3088
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X LP1666 Minnesota

Profile Details

NPI number 1427081413
LBN Legal business name Jefferson, Vaughn Robert
Credentials PSY.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 10th, 2006
Last updated Mar 16th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427081413 NPPES
Minnesota MEDICAID 688750300

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