Provider Demographics
NPI:1346290210
Name:ROLFERT, ANNE THERESE (CCCA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:THERESE
Last Name:ROLFERT
Suffix:
Gender:F
Credentials:CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1858 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1008
Mailing Address - Country:US
Mailing Address - Phone:513-891-1006
Mailing Address - Fax:513-793-1032
Practice Address - Street 1:2825 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-221-0527
Practice Address - Fax:513-221-1703
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01197231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2613774Medicaid
OH4169702Medicare PIN
OH4169701Medicare PIN