Provider Demographics
NPI:1427067297
Name:ROLL, WILLIAM
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:ROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2353
Mailing Address - Country:US
Mailing Address - Phone:812-339-1691
Mailing Address - Fax:812-337-2438
Practice Address - Street 1:831 DILLON DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-8048
Practice Address - Country:US
Practice Address - Phone:765-983-8000
Practice Address - Fax:765-983-8609
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010331A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100474840Medicaid
IN905120BMedicare ID - Type UnspecifiedROLLMEDICAREURBAN