Provider Demographics
NPI:1790186989
Name:WARD, CANDICE (MA, CF)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:MA, CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WILLOW LN
Mailing Address - Street 2:204
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4997
Mailing Address - Country:US
Mailing Address - Phone:302-897-3788
Mailing Address - Fax:
Practice Address - Street 1:3500 MEEKINS DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4894
Practice Address - Country:US
Practice Address - Phone:540-786-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007538235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist