Provider Demographics
NPI:1659981785
Name:KNAUER, CANDICE (RD)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:
Last Name:KNAUER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 THEATER DRIVE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44242-9627
Mailing Address - Country:US
Mailing Address - Phone:330-672-2063
Mailing Address - Fax:
Practice Address - Street 1:1225 THEATER DRIVE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44242-9627
Practice Address - Country:US
Practice Address - Phone:330-672-2063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8041133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty