Provider Demographics
NPI:1750640421
Name:ROOF, KATHERINE DENISE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DENISE
Last Name:ROOF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 VILLA RD STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3038
Mailing Address - Country:US
Mailing Address - Phone:864-271-4321
Mailing Address - Fax:864-271-4473
Practice Address - Street 1:37 VILLA RD STE 300
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3038
Practice Address - Country:US
Practice Address - Phone:864-271-4321
Practice Address - Fax:864-271-4473
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator