MEDICARE: MRS. BERNADINE MARIE ROLNIAK CCC-SLP

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	235Z00000X	Speech-Language Pathologist	17642	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17642	OTHER	TX	TEXAS STATE BOARD OF EXAMINERS

General Provider Information

NPI Number	:	1487891537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BERNADINE MARIE ROLNIAK CCC-SLP

Provider Business Mailing Address
First Line	:	PSC 80
Second Line	:	BOX 21332
City	:	APO
State	:	AP
Zip	:	96367-0098
Country	:	US
Telephone Number	:	719-488-1901
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 482
Second Line	:	BOX 1600
City	:	FPO
State	:	AP
Zip	:	96362-9998
Country	:	US
Telephone Number	:	315-634-2708
Fax Number	:

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

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	01/12/2009

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Directions to “ MRS. BERNADINE MARIE ROLNIAK CCC-SLP” Practice Location

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