Healthcare Provider Details

I. General information

NPI: 1750151346
Provider Name (Legal Business Name): KELLY L ROPER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1586 S 21ST ST
COLORADO SPRINGS CO
80904-4282
US

IV. Provider business mailing address

1586 S 21ST ST STE 20
COLORADO SPRINGS CO
80904-4260
US

V. Phone/Fax

Practice location:
  • Phone: 405-210-6683
  • Fax: 405-251-8538
Mailing address:
  • Phone: 405-210-6683
  • Fax: 405-251-8538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09931905
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: