Provider Demographics
NPI:1659507846
Name:DARNELL, CANDACE LAINE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:LAINE
Last Name:DARNELL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 MC 5032
Mailing Address - Street 2:
Mailing Address - City:YELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72687-7879
Mailing Address - Country:US
Mailing Address - Phone:870-449-5224
Mailing Address - Fax:
Practice Address - Street 1:1117 MC 5032
Practice Address - Street 2:
Practice Address - City:YELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72687-7879
Practice Address - Country:US
Practice Address - Phone:870-449-5224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1478235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist