Provider Demographics
NPI:1073123782
Name:TRUESDELL NOKES, CANDICE (EDS, NCSP)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:TRUESDELL NOKES
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W60N761 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-1351
Mailing Address - Country:US
Mailing Address - Phone:262-339-0857
Mailing Address - Fax:
Practice Address - Street 1:W60N761 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-1351
Practice Address - Country:US
Practice Address - Phone:262-339-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390160103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool