Provider Demographics
NPI:1801830252
Name:GONZALEZ, CANDICE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 W 9000 S STE 1
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2047
Mailing Address - Country:US
Mailing Address - Phone:801-597-9558
Mailing Address - Fax:
Practice Address - Street 1:45 W 9000 S STE 1
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2047
Practice Address - Country:US
Practice Address - Phone:801-597-9558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6086447-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107001404101OtherINTRMTN. HEALTH CARE
UT942938348FOtherEDUCATORS MUTUAL
UT262141OtherDESERET MUTUAL
UT942938348OtherCHAMPUS
UTMF01167OtherDEA
UT1801830252Medicaid
UT00554950Medicare ID - Type UnspecifiedRAILROAD MEDICARE
UT262141OtherDESERET MUTUAL
UTMF01167OtherDEA
UT942938348FOtherEDUCATORS MUTUAL
UT107001404101OtherINTRMTN. HEALTH CARE
UTE004662169Medicare ID - Type UnspecifiedMEDICARE