Healthcare Provider Details

I. General information

NPI: 1952520843
Provider Name (Legal Business Name): SIMONE IRENE ROSELAND M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 N GLENWOOD AVE #3
CHICAGO IL
60640-2219
US

IV. Provider business mailing address

5310 N GLENWOOD AVE #3
CHICAGO IL
60640-2219
US

V. Phone/Fax

Practice location:
  • Phone: 773-944-9437
  • Fax: 773-944-9437
Mailing address:
  • Phone: 773-944-9437
  • Fax: 773-944-9437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: