MEDICARE: MS. KATHERINE MANON ROPER LPHA

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	1041C0700X	Clinical Social Worker	68740	CA

General Provider Information

NPI Number	:	1952432148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE MANON ROPER LPHA

Provider Business Mailing Address
First Line	:	768 PLEASANT VALLEY RD
Second Line	:
City	:	DIAMOND SPRINGS
State	:	CA
Zip	:	95619-9260
Country	:	US
Telephone Number	:	530-621-6290
Fax Number	:

Provider Business Practice Location Address
First Line	:	768 PLEASANT VALLEY RD
Second Line	:
City	:	DIAMOND SPRINGS
State	:	CA
Zip	:	95619-9260
Country	:	US
Telephone Number	:	530-621-6290
Fax Number	:

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	12/09/2015

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