Provider Demographics
NPI:1154447126
Name:OLLILA-ROACH, AMY CORINNE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:CORINNE
Last Name:OLLILA-ROACH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:FOLLANSBEE
Mailing Address - State:WV
Mailing Address - Zip Code:26037-1255
Mailing Address - Country:US
Mailing Address - Phone:304-527-0583
Mailing Address - Fax:
Practice Address - Street 1:840 LEE RD
Practice Address - Street 2:
Practice Address - City:FOLLANSBEE
Practice Address - State:WV
Practice Address - Zip Code:26037-1783
Practice Address - Country:US
Practice Address - Phone:304-527-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist