Provider Demographics
NPI:1861629594
Name:ORTIZ-HAWKINS, CANDICE EVITA (AUD)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:EVITA
Last Name:ORTIZ-HAWKINS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11886 HEALING WAY STE 530
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7917
Mailing Address - Country:US
Mailing Address - Phone:240-670-1200
Mailing Address - Fax:240-719-0534
Practice Address - Street 1:11886 HEALING WAY STE 530
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7917
Practice Address - Country:US
Practice Address - Phone:240-670-1200
Practice Address - Fax:240-719-0534
Is Sole Proprietor?:No
Enumeration Date:2009-06-21
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01505231H00000X
PAAT006280231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1715321005Medicaid