Provider Demographics
NPI:1710236930
Name:BRIDGERS, CANDACE M (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:M
Last Name:BRIDGERS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 DAVELYN CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-6039
Mailing Address - Country:US
Mailing Address - Phone:919-418-5007
Mailing Address - Fax:
Practice Address - Street 1:300 RAND RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-9230
Practice Address - Country:US
Practice Address - Phone:919-418-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist