Provider Demographics
NPI:1245585793
Name:SIMONS, CANDACE ROSENBAUM (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:ROSENBAUM
Last Name:SIMONS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8282 WOODSPUR DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4567
Mailing Address - Country:US
Mailing Address - Phone:248-363-2846
Mailing Address - Fax:
Practice Address - Street 1:8282 WOODSPUR DR
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-4567
Practice Address - Country:US
Practice Address - Phone:248-363-2846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICCC-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist