Provider Demographics
NPI:1407393176
Name:POLAND, IRIS (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:POLAND
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 KELLY CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-2150
Mailing Address - Country:US
Mailing Address - Phone:205-383-7002
Mailing Address - Fax:
Practice Address - Street 1:510 WOLF CREEK RD N
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-2477
Practice Address - Country:US
Practice Address - Phone:205-338-3329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist