Most Relevant Information
Provider Data
| NPI Number: | 1003311853 |
| Provider Name: | JILLIAN BLAINE |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: | 2202008601 |
Most Important Dates
| Enumeration Date: | 03/26/2018 |
| Last Updated: | 03/26/2018 |
Provider Practice Location
1413 LASKIN RD
VIRGINIA BEACH
VA
234516007
Practice Location Phone/Fax
| Phone: | 7572632800 |
| Fax: |
Provider Mailing Location
2117 WALPOLE ST
VIRGINIA BEACH
VA
234561276
Provider Mailing Phone/Fax
| Phone: | 7325016910 |
| Fax: |