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General NPI Number Information
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NPI Number | 1336113075
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Entity Type | Individual
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Provider Name | CARROLL D ROLAND PHD
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Gender | Male
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 819 OLYMPIC DR
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City | WATERLOO
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State | IA
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Zip | 50701-4815
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Country | US
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Telephone | 319-234-1227
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Fax | 319-233-0722
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Provider Business Mailing Address
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Address Line | PO BOX 2818
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City | WATERLOO
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State | IA
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Zip | 50704-2818
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Country | US
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Telephone | 319-233-3044
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Fax | 319-233-0722
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 120
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License Number State | IA
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