Provider Demographics
NPI:1619485034
Name:BARRON, CANDACE FRANKLIN (MS)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:FRANKLIN
Last Name:BARRON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:CANDACE
Other - Middle Name:MARIE
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CF-SLP
Mailing Address - Street 1:207 W JACKSON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2355
Mailing Address - Country:US
Mailing Address - Phone:601-362-0859
Mailing Address - Fax:601-362-0870
Practice Address - Street 1:207 W JACKSON ST STE 2
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157
Practice Address - Country:US
Practice Address - Phone:601-362-0859
Practice Address - Fax:601-367-0870
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS4392235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSS4392OtherMISSISSIPPI STATE DEPARTMENT OF HEALTH