Provider Demographics
NPI:1861544934
Name:ROPER, BRIAN DOUGLAS (PHD, MS CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DOUGLAS
Last Name:ROPER
Suffix:
Gender:M
Credentials:PHD, MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3949 BENTLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3900
Mailing Address - Country:US
Mailing Address - Phone:917-674-0536
Mailing Address - Fax:
Practice Address - Street 1:3949 BENTLEY AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3900
Practice Address - Country:US
Practice Address - Phone:917-674-0536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 18963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP 18963OtherCALIFORNIA SPEECH-LANGUAGE PATHOLOGY LICENSE