Provider Demographics
NPI:1760685283
Name:NOONAN, CANDACE LYNN (MS SLP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:LYNN
Last Name:NOONAN
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 EMERY ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-5003
Mailing Address - Country:US
Mailing Address - Phone:618-531-8800
Mailing Address - Fax:
Practice Address - Street 1:311 CAMELOT DR
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4815
Practice Address - Country:US
Practice Address - Phone:618-531-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.000490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist