MEDICARE: KELLY J ROPER M.S. CCC-SLP

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	235Z00000X	Speech-Language Pathologist	2202006619	VA

General Provider Information

NPI Number	:	1356652226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY J ROPER M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	7001 LOISDALE RD
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22150-1904
Country	:	US
Telephone Number	:	703-971-0602
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 LOISDALE RD
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22150-1904
Country	:	US
Telephone Number	:	703-971-0602
Fax Number	:

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

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	11/16/2012

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