Provider Demographics
NPI:1497916936
Name:MCCANDLESS, MICHAEL JOHN (AUD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:MCCANDLESS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W LINCOLN HWY
Mailing Address - Street 2:STE 50
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2521
Mailing Address - Country:US
Mailing Address - Phone:610-363-1340
Mailing Address - Fax:610-363-9694
Practice Address - Street 1:407 W LINCOLN HWY
Practice Address - Street 2:STE 50
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2521
Practice Address - Country:US
Practice Address - Phone:610-363-1340
Practice Address - Fax:610-363-9694
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAZ538231H00000X
PAAT006163231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103215047-0001Medicaid
FLBB968ZOtherMEDICARE ID
PA103215047-0001Medicaid
FLBB968ZOtherMEDICARE ID