Provider Demographics
NPI:1407054836
Name:MACINTIRE, CANDACE MARY (SLP)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:MARY
Last Name:MACINTIRE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:MARY
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 2281
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9644
Mailing Address - Country:US
Mailing Address - Phone:570-421-0452
Mailing Address - Fax:
Practice Address - Street 1:701 SLATE BELT BLVD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-9341
Practice Address - Country:US
Practice Address - Phone:610-599-1454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003194L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist