Provider Demographics
NPI:1285882498
Name:ROULAND, JILL LYNN (SLP)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:LYNN
Last Name:ROULAND
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 W WASHINGTON ST
Mailing Address - Street 2:REGENCY NURSING CARE RESIDENCE- THERAPY DEPT.
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-4630
Mailing Address - Country:US
Mailing Address - Phone:217-793-4880
Mailing Address - Fax:
Practice Address - Street 1:2120 W WASHINGTON ST
Practice Address - Street 2:REGENCY NURSING CARE RESIDENCE
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4630
Practice Address - Country:US
Practice Address - Phone:217-793-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.000824235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist