Individual provider Active NPI

Guy Joseph Vinette II, CCC-SLP

  • Speech-Language Pathologist
  • Moncks Corner, SC
National Provider Identifier
1164916359
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
6561 Issued in SC
Practice address
421 Barony St Ste 3
Moncks Corner, SC 29461-3145
Phone
(843) 790-4093
Fax
(843) 501-2297
NPI assigned
Jun 20, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 6561 SC Primary

Addresses

Primary practice location

421 Barony St Ste 3
Moncks Corner, SC 29461-3145

Mailing address

421 Barony St Ste 3
Moncks Corner, SC 29461-3145
Phone (843) 790-4093

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181016000156 SC Practitioner - Qualified Speech Language Pathologist 2769734029 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6561SCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Vantage Early Intervention, LLC CurrentSince Aug 18, 2024 Accepting new patients

Locations

421 Barony St
Ste 3
Moncks Corner, SC 29461
Phone (843) 513-4960

Organizations & group practices 2

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": "1529452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1164916359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 BARONY ST STE 3",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294613145",
            "telephone_number": "843-790-4093",
            "fax_number": "843-501-2297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 BARONY ST STE 3",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294613145",
            "telephone_number": "843-790-4093",
            "fax_number": "843-501-2297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINETTE",
        "first_name": "GUY",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-20",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "6561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moncks Corner, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.