MEDICARE: CANDACE ROPER IBCLC

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	174N00000X	Lactation Consultant (Non-RN)	L-303756	VA

General Provider Information

NPI Number	:	1053139832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE ROPER IBCLC

Provider Business Mailing Address
First Line	:	3383 E BENGAL BLVD APT 8
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-5831
Country	:	US
Telephone Number	:	801-450-1535
Fax Number	:

Provider Business Practice Location Address
First Line	:	3383 E BENGAL BLVD APT 8
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-5831
Country	:	US
Telephone Number	:	801-450-1535
Fax Number	:

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

Provider Enumeration Date	:	09/30/2024
Last Update Date	:	09/30/2024

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Directions to “ CANDACE ROPER IBCLC” Practice Location

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