Individual
JILL BAIN WINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
5254 POTOMAC DR STE A, KING GEORGE, VA 22485
(540) 850-3940
(571) 550-9758
Mailing address
7072 KITCHEN DR, KING GEORGE, VA 22485-5225
(540) 850-3940
(571) 550-9758
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202007993
VA
Other
Enumeration date
12/21/2015
Last updated
07/14/2018
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