Provider Demographics
NPI:1053139832
Name:ROPER, CANDACE (IBCLC)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:ROPER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3383 E BENGAL BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5831
Mailing Address - Country:US
Mailing Address - Phone:801-450-1535
Mailing Address - Fax:
Practice Address - Street 1:3383 E BENGAL BLVD APT 8
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-5831
Practice Address - Country:US
Practice Address - Phone:801-450-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAL-303756174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN