Samantha Juliet Sophiea-Fairmont, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

242.005472 Issued in IL

Practice address

400 Linden Ave Ste 11
Wilmette, IL 60091-3607

Phone

(517) 927-0202

NPI assigned

Aug 10, 2020

Last updated

Aug 10, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597017600000",
    "number": "1619587128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 W HILL ST APT 810",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606102535",
            "telephone_number": "517-927-0202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 LINDEN AVE STE 11",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600913607",
            "telephone_number": "517-927-0202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOPHIEA-FAIRMONT",
        "first_name": "SAMANTHA",
        "middle_name": "JULIET",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-10",
        "last_updated": "2020-08-10",
        "certification_date": "2020-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242.005472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ssophiea-fairmont@languageandlearn.com",
            "affiliation": "N",
            "address_1": "400 Linden Ave Ste 11",
            "city": "Wilmette",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600913607",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Speech-Language Pathologist in Wilmette, IL
• Providers in Wilmette, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.