Provider Demographics
NPI:1376256859
Name:CANDIELLO, KATELYN ROSE
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:ROSE
Last Name:CANDIELLO
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 1:636 PETERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-8816
Mailing Address - Country:US
Mailing Address - Phone:717-823-3969
Mailing Address - Fax:
Practice Address - Street 1:2009 SPRINGWOOD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4836
Practice Address - Country:US
Practice Address - Phone:717-851-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015939235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist