Provider Demographics
NPI:1760918288
Name:REED, MCCALL CANDICE (MS)
Entity Type:Individual
Prefix:
First Name:MCCALL
Middle Name:CANDICE
Last Name:REED
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 N RACE AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4460
Mailing Address - Country:US
Mailing Address - Phone:847-525-8621
Mailing Address - Fax:
Practice Address - Street 1:657 W BITTERSWEET PL
Practice Address - Street 2:2W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2307
Practice Address - Country:US
Practice Address - Phone:312-650-5522
Practice Address - Fax:312-878-7112
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program