Provider Demographics
NPI:1760025829
Name:ROLLE, TAMMI (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:
Last Name:ROLLE
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 1:8801 RITCHIE DR
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-4900
Mailing Address - Country:US
Mailing Address - Phone:301-808-8100
Mailing Address - Fax:
Practice Address - Street 1:8801 RITCHIE DR
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-4900
Practice Address - Country:US
Practice Address - Phone:301-808-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02766235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist