Provider Demographics
NPI:1386000453
Name:ROLAPE, KRISTIE ANN (MS-CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:ANN
Last Name:ROLAPE
Suffix:
Gender:F
Credentials:MS-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 DEERWOOD AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1051
Mailing Address - Country:US
Mailing Address - Phone:407-797-6651
Mailing Address - Fax:
Practice Address - Street 1:4511 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4001
Practice Address - Country:US
Practice Address - Phone:502-419-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY315211235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100208710Medicaid