Provider Demographics
NPI:1487891537
Name:ROLNIAK, BERNADINE MARIE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BERNADINE
Middle Name:MARIE
Last Name:ROLNIAK
Suffix:
Gender:F
Credentials: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:PSC 80
Mailing Address - Street 2:BOX 21332
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-0098
Mailing Address - Country:US
Mailing Address - Phone:719-488-1901
Mailing Address - Fax:
Practice Address - Street 1:PSC 482
Practice Address - Street 2:BOX 1600
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96362-9998
Practice Address - Country:US
Practice Address - Phone:315-634-2708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17642235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17642OtherTEXAS STATE BOARD OF EXAMINERS