Healthcare Provider Details

I. General information

NPI: 1356484489
Provider Name (Legal Business Name): CAROL P ROLLAND PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 N WILTON AVE PEDIATRIC DEVELOPMENTAL CENTER
CHICAGO IL
60657-4424
US

IV. Provider business mailing address

1450 N ASTOR ST APT. 6B
CHICAGO IL
60610-1672
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-7340
  • Fax:
Mailing address:
  • Phone: 312-643-5177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: