Provider Demographics
NPI:1922474220
Name:MOTTWEILER, CANDICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:
Last Name:MOTTWEILER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 RIVER AVE UNIT 40152
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-0803
Mailing Address - Country:US
Mailing Address - Phone:541-246-7828
Mailing Address - Fax:
Practice Address - Street 1:2580 HILYARD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3684
Practice Address - Country:US
Practice Address - Phone:541-246-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3049103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical