Provider Demographics
NPI:1568799609
Name:STADTLER, CANDACE (BCBA)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:STADTLER
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 1:14914 HAMLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-3431
Mailing Address - Country:US
Mailing Address - Phone:708-268-4042
Mailing Address - Fax:
Practice Address - Street 1:14914 HAMLIN AVE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-3431
Practice Address - Country:US
Practice Address - Phone:708-268-4042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2013-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-09-5722103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst