Provider Demographics
NPI:1467928457
Name:ROUDEBUSH, CANDACE KAY (DEVELOPMENTAL THERAP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:KAY
Last Name:ROUDEBUSH
Suffix:
Gender:F
Credentials:DEVELOPMENTAL THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140
Mailing Address - Country:US
Mailing Address - Phone:317-498-0100
Mailing Address - Fax:
Practice Address - Street 1:1342 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140
Practice Address - Country:US
Practice Address - Phone:317-498-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist