Provider Demographics
NPI:1073959011
Name:BYNUM, KANDYCE KINTE
Entity Type:Individual
Prefix:MISS
First Name:KANDYCE
Middle Name:KINTE
Last Name:BYNUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 W 112TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-4639
Mailing Address - Country:US
Mailing Address - Phone:312-363-9120
Mailing Address - Fax:
Practice Address - Street 1:1044 W 112TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4639
Practice Address - Country:US
Practice Address - Phone:312-363-9120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist