Provider Demographics
NPI:1952520843
Name:ROSELAND, SIMONE IRENE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:IRENE
Last Name:ROSELAND
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5310 N GLENWOOD AVE
Mailing Address - Street 2:#3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2219
Mailing Address - Country:US
Mailing Address - Phone:773-944-9437
Mailing Address - Fax:773-944-9437
Practice Address - Street 1:5310 N GLENWOOD AVE
Practice Address - Street 2:#3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2219
Practice Address - Country:US
Practice Address - Phone:773-944-9437
Practice Address - Fax:773-944-9437
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist