Basic Information
| Provider Information | |||||||||
| NPI: | 1720105778 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROLEY | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 HEALTH CENTER DR | ||||||||
| Address2: | |||||||||
| City: | MATTOON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619389253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172582525 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 N MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624011779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173471243 | ||||||||
| FaxNumber: | 2173471558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 12/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 146.007565 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.