MEDICARE: MRS. MARKIDA JENISE ROPER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	159106666	IL

General Provider Information

NPI Number	:	1093527871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARKIDA JENISE ROPER

Provider Business Mailing Address
First Line	:	301 S WALL ST
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-3240
Country	:	US
Telephone Number	:	618-713-2786
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 E GRAND AVE
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-3422
Country	:	US
Telephone Number	:	618-713-2786
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	01/21/2025

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