Provider Demographics
NPI:1497903850
Name:ADAMS, CANDICE FERN (MACCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:FERN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MACCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 KAITLYN DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-3435
Mailing Address - Country:US
Mailing Address - Phone:309-661-2720
Mailing Address - Fax:
Practice Address - Street 1:2505 KAITLYN DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3435
Practice Address - Country:US
Practice Address - Phone:309-661-2720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146003760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist