Provider Demographics
NPI:1811368269
Name:GREGG, KANDICE (MSW)
Entity Type:Individual
Prefix:
First Name:KANDICE
Middle Name:
Last Name:GREGG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19545 BROADHURST RD
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-8567
Mailing Address - Country:US
Mailing Address - Phone:530-354-3223
Mailing Address - Fax:
Practice Address - Street 1:19545 BROADHURST RD
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:CA
Practice Address - Zip Code:96022-8567
Practice Address - Country:US
Practice Address - Phone:530-354-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker