Provider Demographics
NPI:1437898574
Name:ROPER, ANGELISA SMITH (NCSP)
Entity Type:Individual
Prefix:MS
First Name:ANGELISA
Middle Name:SMITH
Last Name:ROPER
Suffix:
Gender:F
Credentials:NCSP
Other - Prefix:MS
Other - First Name:ANGELISA
Other - Middle Name:
Other - Last Name:ROPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NCSP
Mailing Address - Street 1:3665 S ROWAN CV
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84128-2402
Mailing Address - Country:US
Mailing Address - Phone:801-550-7671
Mailing Address - Fax:
Practice Address - Street 1:9361 S 300 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2902
Practice Address - Country:US
Practice Address - Phone:801-826-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51477103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool