Provider Demographics
NPI:1154442242
Name:ROBINSON, CANDACE GRAHAM (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:GRAHAM
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:RENEE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 EAST JOPPA ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234
Mailing Address - Country:US
Mailing Address - Phone:410-944-3100
Mailing Address - Fax:866-643-0039
Practice Address - Street 1:1629 YORK RD STE C
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5633
Practice Address - Country:US
Practice Address - Phone:443-578-3900
Practice Address - Fax:866-380-1308
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00744231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD284403600Medicaid
MD400941ZAUMedicare PIN