Provider Demographics
NPI:1619587912
Name:VINTINNER, JAIME R (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:R
Last Name:VINTINNER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 TAYLOR LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:ME
Mailing Address - Zip Code:04055-5152
Mailing Address - Country:US
Mailing Address - Phone:413-362-2476
Mailing Address - Fax:
Practice Address - Street 1:322 W GRAY RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-9574
Practice Address - Country:US
Practice Address - Phone:207-822-6740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP3258235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist