MEDICARE: JENNIFER MARIE ROLAND M.S. 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	146005339	IL

General Provider Information

NPI Number	:	1629380126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE ROLAND M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	503 CHAPMAN ST
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-1860
Country	:	US
Telephone Number	:	618-659-9084
Fax Number	:

Provider Business Practice Location Address
First Line	:	1373 DADRIAN PROFESSIONAL PARK
Second Line	:
City	:	GODFREY
State	:	IL
Zip	:	62035-1686
Country	:	US
Telephone Number	:	618-468-8010
Fax Number	:	618-467-7065

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

Provider Enumeration Date	:	07/13/2010
Last Update Date	:	07/13/2010

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Directions to “ JENNIFER MARIE ROLAND M.S. CCC-SLP” Practice Location

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