Samantha Lynn Vaillancourt, M.ED. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA11737 Issued in FL

Practice address

4907 NW 43Rd St Ste C
Gainesville, FL 32606-2007

Phone

(352) 372-0047

NPI assigned

Nov 13, 2017

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

Other names 1

• Ms. Samantha Lynn Green Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

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.

• Acg Therapy Center, Inc

  • Behavior Analyst
  • Gainesville, FL
  • NPI 1588651921

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1510531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510531200000",
    "number": "1871006874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 NW 39TH AVE APT M104",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326066951",
            "telephone_number": "810-886-2243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4907 NW 43RD ST STE C",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326062007",
            "telephone_number": "352-372-0047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAILLANCOURT",
        "first_name": "SAMANTHA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "M.ED. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-13",
        "last_updated": "2017-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA11737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "GREEN",
            "middle_name": "LYNN",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• VA
• Ahmad Zargar Vafa, MD
• Shruti Sanjay Vaghasia, DO
• Sayedeh Cherareh Vahedi, CPHT.
• Leah Vail
• John B Vairo, DMD
• Vibeke Vala, P.T
• Lily Valad
• Natalia Shawna-Kiersey Valais, ARNP
• Carolina Eglee Valdes-Guicciardi, MD

• Speech-Language Pathologist in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2017; 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.