Provider Demographics
NPI:1891050746
Name:GRUDOWSKI, CANDICE NICOLE (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:NICOLE
Last Name:GRUDOWSKI
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 WARREN LN
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-3218
Mailing Address - Country:US
Mailing Address - Phone:847-549-9341
Mailing Address - Fax:
Practice Address - Street 1:1675 DEMPSTER STREET
Practice Address - Street 2:PEDIATRIC THERAPY DEPARTMENT
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-723-4532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.002239235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist