Basic Information
| Provider Information | |||||||||
| NPI: | 1740798537 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROPER | ||||||||
| FirstName: | KATYE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 902 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WEST FRANKFORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628962210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189376483 | ||||||||
| FaxNumber: | 6189371440 | ||||||||
| Practice Location | |||||||||
| Address1: | 3111 WILLIAMSON COUNTY PKWY | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629595235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189973647 | ||||||||
| FaxNumber: | 6189699437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2018 | ||||||||
| LastUpdateDate: | 06/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 150.102969 | IL | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 149021316 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.