Provider Demographics
NPI:1255469946
Name:HAFTL, CANDACE LORRAINE (MA)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:LORRAINE
Last Name:HAFTL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 DEVON DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1744
Mailing Address - Country:US
Mailing Address - Phone:610-280-3704
Mailing Address - Fax:
Practice Address - Street 1:401 GORDON DR STE A
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1276
Practice Address - Country:US
Practice Address - Phone:610-280-9201
Practice Address - Fax:610-280-0182
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005166L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019373540003Medicare ID - Type UnspecifiedMA