Provider Demographics
NPI:1184871824
Name:ROLAND, AMY LOVE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:LOVE
Last Name:ROLAND
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 1:1315 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-1105
Mailing Address - Country:US
Mailing Address - Phone:574-532-3051
Mailing Address - Fax:
Practice Address - Street 1:316 WOODIES LN
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:IN
Practice Address - Zip Code:46506-1354
Practice Address - Country:US
Practice Address - Phone:574-546-3494
Practice Address - Fax:574-546-3199
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004328A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist