Provider Demographics
NPI:1043406572
Name:CANDIA, MARCOS CHRISTIAN (MS-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:CHRISTIAN
Last Name:CANDIA
Suffix:
Gender:M
Credentials: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 1:711 AUTUMN GLEN LN
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3070
Mailing Address - Country:US
Mailing Address - Phone:636-327-5448
Mailing Address - Fax:
Practice Address - Street 1:13190 S OUTER 40
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5917
Practice Address - Country:US
Practice Address - Phone:314-991-1193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004014080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist