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General NPI Number Information
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NPI Number | 1922297050
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Entity Type | Organization
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Legal Business Name | ROLANDA M SMITH
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 430 E 162ND ST STE 430
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2258
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Country | US
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Telephone | 708-201-0058
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Fax | 888-646-5822
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Provider Business Mailing Address
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Address Line | 430 E 162ND ST STE 430
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2258
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Country | US
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Telephone | 708-201-0058
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Fax | 888-646-5822
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Authorized Official
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Title or Position | DEVELOPMENTAL THERAPIST
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Name | MISS ROLANDA M SMITH
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Credential |
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Telephone | 708-201-0058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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