Provider Demographics
NPI:1528378163
Name:ROPER, LISA MARIE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:ROPER
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 INTERNATIONAL CIR
Mailing Address - Street 2:#100
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1321
Mailing Address - Country:US
Mailing Address - Phone:410-667-7200
Mailing Address - Fax:
Practice Address - Street 1:910 OAKHILL ROAD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35504
Practice Address - Country:US
Practice Address - Phone:205-387-0564
Practice Address - Fax:205-387-0568
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008330235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist