Provider Demographics
NPI:1790551091
Name:BOSS, CANDICE MELINE (QMHP-R)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:MELINE
Last Name:BOSS
Suffix:
Gender:F
Credentials:QMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 SAGINAW ST S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4121
Mailing Address - Country:US
Mailing Address - Phone:503-362-1999
Mailing Address - Fax:503-362-9671
Practice Address - Street 1:821 SAGINAW ST S # 35
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4121
Practice Address - Country:US
Practice Address - Phone:503-362-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator