Provider Demographics
NPI:1609004852
Name:TITO, KANDIE
Entity Type:Individual
Prefix:
First Name:KANDIE
Middle Name:
Last Name:TITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 CARLETON DR UNIT 13
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-7412
Mailing Address - Country:US
Mailing Address - Phone:910-367-8208
Mailing Address - Fax:
Practice Address - Street 1:5006 CARLETON DR UNIT 13
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7412
Practice Address - Country:US
Practice Address - Phone:910-367-8208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist