Provider Demographics
NPI:1063907731
Name:VANTAGE SPEECH & LANGUAGE LLC
Entity type:Organization
Organization Name:VANTAGE SPEECH & LANGUAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:VINETTE
Authorized Official - Suffix:II
Authorized Official - Credentials:CCC, SLP
Authorized Official - Phone:843-790-4093
Mailing Address - Street 1:421 BARONY ST SUITE 3
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3145
Mailing Address - Country:US
Mailing Address - Phone:843-790-4093
Mailing Address - Fax:843-501-2297
Practice Address - Street 1:421 BARONY ST SUITE 3
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3145
Practice Address - Country:US
Practice Address - Phone:843-790-4093
Practice Address - Fax:843-501-2297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP9008Medicaid