Healthcare Provider Details

I. General information

NPI: 1528982675
Provider Name (Legal Business Name): JACQUELINE MARIE BENTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 SENSENY RD
WINCHESTER VA
22602-6421
US

IV. Provider business mailing address

1481 SENSENY RD
WINCHESTER VA
22602-6421
US

V. Phone/Fax

Practice location:
  • Phone: 540-665-0103
  • Fax:
Mailing address:
  • Phone: 540-665-0103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202012574
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.0006706
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7815
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: