Samantha Jean Vollertsen

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

17-35394 Issued in FL

Practice address

2331 Hansen Court
Tallahassee, FL 32301

Phone

(850) 320-6555

Fax

(888) 873-4610

NPI assigned

Mar 20, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Ms. Samantha Jean Hackmann Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Cayer Behavioral Group, Inc

  • Behavior Analyst
  • Tallahassee, FL
  • NPI 1225362056
  NPD (past)

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

{
    "created_epoch": "1489968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549929600000",
    "number": "1821539115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2331 HANSEN COURT",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "32301",
            "telephone_number": "850-320-6555",
            "fax_number": "888-873-4610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2331 HANSEN COURT",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "32301",
            "telephone_number": "850-320-6555",
            "fax_number": "888-873-4610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VOLLERTSEN",
        "first_name": "SAMANTHA",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-20",
        "last_updated": "2019-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "17-35394",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RBT",
            "identifier": "17-35394",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024665300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "HACKMANN",
            "middle_name": "JEAN",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ashley Vo
• Voans Senior Community Care of Florida
• Brian Christopher Vogt, APRN
• Ernest Martin Volaric, DC
• Joanne Volcy
• David Voorting, LCSW
• Jessica Vose
• Ava Katarina Voss, MD
• Chelsea Keen Vrana
• Chau-Vy Vu

• Behavior Technician in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Behavior Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 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.

Verify at the official NPI Registry.