Active NPI
Nicole Sophia St. Amand, M.S., CCC-SLP
- Speech-Language Pathologist
- Rutland, MA
National Provider Identifier
1124684022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 76747
- Practice address
- 62 Emerald Rd
Rutland, MA 01543-1536 - Phone
- (413) 537-3407
- NPI assigned
- May 15, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 76747 | MA | Primary |
Addresses
Primary practice location
62 Emerald Rd
Rutland, MA 01543-1536
Mailing address
62 Emerald Rd
Rutland, MA 01543-1536
Phone (413) 537-3407
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 76747 | MA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Sea Therapy, LLC | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557878400000",
"number": "1124684022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "62 EMERALD RD",
"city": "RUTLAND",
"state": "MA",
"postal_code": "015431536",
"telephone_number": "413-537-3407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "62 EMERALD RD",
"city": "RUTLAND",
"state": "MA",
"postal_code": "015431536",
"telephone_number": "413-537-3407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ST. AMAND",
"first_name": "NICOLE",
"middle_name": "SOPHIA",
"name_prefix": "Mrs.",
"credential": "M.S., CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-15",
"last_updated": "2019-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": "MA",
"license": "76747",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rutland, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.