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NPI Code Detail

MEDICARE: DAWN MARIE ROULANAITIS MS CCC-A

MEDICARE: DAWN MARIE ROULANAITIS MS CCC-A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1231H00000XAudiologist147000823IL

General Provider Information

NPI Number : 1033131164
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAWN MARIE ROULANAITIS MS CCC-A
Provider Business Mailing Address
First Line : 19 WOLF CREEK DR
Second Line :
City : SWANSEA
State : IL
Zip : 62226-2355
Country : US
Telephone Number : 618-235-3687
Fax Number : 618-239-9492
Provider Business Practice Location Address
First Line : 19 WOLF CREEK DR
Second Line :
City : SWANSEA
State : IL
Zip : 62226-2355
Country : US
Telephone Number : 618-235-3687
Fax Number : 618-239-9492
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 06/12/2008

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