Provider Demographics
NPI:1396800439
Name:MASTERS, CANDICE LEIGH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:LEIGH
Last Name:MASTERS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 SUMNER ST APT 4
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1964
Mailing Address - Country:US
Mailing Address - Phone:617-686-0210
Mailing Address - Fax:617-916-2642
Practice Address - Street 1:206 SUMNER ST APT 4
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1964
Practice Address - Country:US
Practice Address - Phone:617-686-0210
Practice Address - Fax:617-916-2642
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5892235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist