Healthcare Provider Details

I. General information

NPI: 1417697855
Provider Name (Legal Business Name): SAMANTHA LYNN VINCENT SWLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 08/07/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2282 US HIGHWAY 93 S
KALISPELL MT
59901-8499
US

IV. Provider business mailing address

905 TRAILS END RD
EUREKA MT
59917
US

V. Phone/Fax

Practice location:
  • Phone: 406-890-2570
  • Fax: 406-203-9949
Mailing address:
  • Phone: 406-885-0961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberBBH-SWLC-LIC-38653
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: