MEDICARE: MRS. RUTH DANIELLE ROPER M.A., SLP-CCC

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	2007022816	MO

General Provider Information

NPI Number	:	1629124086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RUTH DANIELLE ROPER M.A., SLP-CCC

Provider Business Mailing Address
First Line	:	4924 NAGEL AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-4029
Country	:	US
Telephone Number	:	636-219-7611
Fax Number	:

Provider Business Practice Location Address
First Line	:	4924 NAGEL AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-4029
Country	:	US
Telephone Number	:	636-219-7611
Fax Number	:

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	08/07/2014

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