Provider Demographics
NPI:1003235847
Name:HARRELSON, CANDACE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:
Last Name:HARRELSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:KOPECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:32207 TAMINA RD # SITEA
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2556
Mailing Address - Country:US
Mailing Address - Phone:832-734-6131
Mailing Address - Fax:
Practice Address - Street 1:32207 TAMINA RD # SITEA
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2556
Practice Address - Country:US
Practice Address - Phone:832-734-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist