Provider Demographics
NPI:1063036838
Name:ROLSTON, SHERIL AMILIA
Entity Type:Individual
Prefix:
First Name:SHERIL
Middle Name:AMILIA
Last Name:ROLSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 S DELEWARE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MI
Mailing Address - Zip Code:48880
Mailing Address - Country:US
Mailing Address - Phone:913-787-1026
Mailing Address - Fax:
Practice Address - Street 1:223 S DELEWARE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MI
Practice Address - Zip Code:48880
Practice Address - Country:US
Practice Address - Phone:913-787-1026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No156F00000XEye and Vision Services ProvidersTechnician/Technologist