Provider Demographics
NPI:1184021222
Name:STOOPS, CANDICE EVALYN (LMT)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:EVALYN
Last Name:STOOPS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1697 BARNES AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-1053
Mailing Address - Country:US
Mailing Address - Phone:503-507-4797
Mailing Address - Fax:
Practice Address - Street 1:1697 BARNES AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-1053
Practice Address - Country:US
Practice Address - Phone:503-507-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19034171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor