Individual
CANDACE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
199 HOME RD, JUNEAU, WI 53039-1401
(920) 386-3548
Mailing address
933 POPLAR ST, WEST BEND, WI 53095-3136
(262) 306-8809
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1371-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42745500
—
WI
Enumeration date
08/16/2006
Last updated
07/08/2007
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