Provider Demographics
NPI:1861816209
Name:CAESAR, CANDICE LUCINDA
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:LUCINDA
Last Name:CAESAR
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CANDICE
Other - Middle Name:LUCINDA
Other - Last Name:JEFFERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:4750 CHISHOLM HOLW
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-2038
Mailing Address - Country:US
Mailing Address - Phone:832-654-1916
Mailing Address - Fax:
Practice Address - Street 1:4750 CHISHOLM HOLW
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-2038
Practice Address - Country:US
Practice Address - Phone:832-654-1916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist