MEDICARE: DR. CAROL P ROLLAND PHD

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
1	103T00000X	Psychologist		IL

General Provider Information

NPI Number	:	1356484489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL P ROLLAND PHD

Provider Business Mailing Address
First Line	:	1450 N ASTOR ST
Second Line	:	APT. 6B
City	:	CHICAGO
State	:	IL
Zip	:	60610-1672
Country	:	US
Telephone Number	:	312-643-5177
Fax Number	:

Provider Business Practice Location Address
First Line	:	3040 N WILTON AVE
Second Line	:	PEDIATRIC DEVELOPMENTAL CENTER
City	:	CHICAGO
State	:	IL
Zip	:	60657-4424
Country	:	US
Telephone Number	:	773-296-7340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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