Provider Demographics
NPI:1801904727
Name:HINE, PATRICIA LYNNE (MA CCC SLP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LYNNE
Last Name:HINE
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1603 LOZANO DRIVE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182
Mailing Address - Country:US
Mailing Address - Phone:703-863-4590
Mailing Address - Fax:
Practice Address - Street 1:3750 OLD LEE HIGHWAY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-1806
Practice Address - Country:US
Practice Address - Phone:703-246-7308
Practice Address - Fax:703-246-7307
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202000841235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist