Provider Demographics
NPI:1053640755
Name:ZWEIFEL, CANDACE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:ZWEIFEL
Suffix:
Gender:F
Credentials:MA 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:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:VIBORG
Mailing Address - State:SD
Mailing Address - Zip Code:57070-0368
Mailing Address - Country:US
Mailing Address - Phone:605-326-5161
Mailing Address - Fax:605-326-5734
Practice Address - Street 1:315 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:VIBORG
Practice Address - State:SD
Practice Address - Zip Code:57070-2002
Practice Address - Country:US
Practice Address - Phone:605-326-5161
Practice Address - Fax:605-326-5734
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD12095872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD12095872OtherLICENSE