Provider Demographics
NPI:1093007072
Name:PURCELL, CANDANCE (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CANDANCE
Middle Name:
Last Name:PURCELL
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:CANDANCE
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1979 LAKESIDE PARKWAY SUITE 800
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084
Mailing Address - Country:US
Mailing Address - Phone:866-507-3049
Mailing Address - Fax:
Practice Address - Street 1:1979 LAKESIDE PARKWAY SUITE 800
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:866-507-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-4788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK531OtherAK
NMC-4788OtherSTATE OF NEW MEXICO REGULATION & LICENSING DEPARTMENT