Provider Demographics
NPI:1184443319
Name:WATLEY, CANDACE (SLPA)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:WATLEY
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9104 BOWIE RDG
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-3211
Mailing Address - Country:US
Mailing Address - Phone:830-832-6717
Mailing Address - Fax:
Practice Address - Street 1:1431 GREENWAY DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2448
Practice Address - Country:US
Practice Address - Phone:877-688-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant