Provider Demographics
NPI:1609574961
Name:PELFREY, CANDACE ROCHELLE (LMA, CLT)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:ROCHELLE
Last Name:PELFREY
Suffix:
Gender:F
Credentials:LMA, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 HARRODSBURG RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3516
Mailing Address - Country:US
Mailing Address - Phone:859-257-5349
Mailing Address - Fax:
Practice Address - Street 1:2195 HARRODSBURG RD FL 2
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3516
Practice Address - Country:US
Practice Address - Phone:859-323-8082
Practice Address - Fax:859-257-5901
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700017452225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist