Provider Demographics
NPI:1386041523
Name:POGGE, CANDICE (BCBA)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:POGGE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 RIVER PARK DR STE 285
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4522
Mailing Address - Country:US
Mailing Address - Phone:818-345-2345
Mailing Address - Fax:818-758-8015
Practice Address - Street 1:1250 S CAPITAL OF TEXAS HWY STE 400
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6446
Practice Address - Country:US
Practice Address - Phone:877-264-6747
Practice Address - Fax:818-758-8015
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-10337103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst