MEDICARE: HEIDI VAILLANCOURT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	175M00000X	Lay Midwife	MA
2	176B00000X	Midwife	MA
3	374J00000X	Doula	MA

General Provider Information

NPI Number	:	1841159514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI VAILLANCOURT

Provider Business Mailing Address
First Line	:	14 BOWDOIN ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-3262
Country	:	US
Telephone Number	:	774-262-3684
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 BOWDOIN ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-3262
Country	:	US
Telephone Number	:	774-262-3684
Fax Number	:	774-262-3684

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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Directions to “ HEIDI VAILLANCOURT ” Practice Location

Language	Start Address	Practice Location

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