Jill Bain Wine, M.A., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2202007993 Issued in VA

Practice address

5254 Potomac Dr Ste a
King George, VA 22485

Phone

(540) 850-3940

Fax

(571) 550-9758

NPI assigned

Dec 21, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fleming Therapy Services, LLC

  • Speech-Language Pathologist
  • Stafford, VA
  • NPI 1194925818
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531526400000",
    "number": "1881059624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7072 KITCHEN DR",
            "city": "KING GEORGE",
            "state": "VA",
            "postal_code": "224855225",
            "telephone_number": "540-850-3940",
            "fax_number": "571-550-9758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5254 POTOMAC DR STE A",
            "city": "KING GEORGE",
            "state": "VA",
            "postal_code": "22485",
            "telephone_number": "540-850-3940",
            "fax_number": "571-550-9758"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2765 Jefferson Davis Hwy",
            "address_2": "Ste. 203",
            "address_purpose": "LOCATION",
            "city": "Stafford",
            "state": "VA",
            "postal_code": "225548331",
            "country_code": "US",
            "telephone_number": "540-720-2261",
            "fax_number": "540-720-5660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WINE",
        "first_name": "JILL",
        "middle_name": "BAIN",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-21",
        "last_updated": "2018-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202007993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason J Wheeler, MS/CAGS
• Tracy Whitaker
• April Y Whiting
• Natasha Williams, CNA
• Pauline Wills, M.A., CCC-SLP
• La Wanda Wright
• Alena Yaseva
• Ilya Zavelsky, M.D.

• Speech-Language Pathologist in King George, VA
• Providers in King George, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.