Provider Demographics
NPI:1457798860
Name:COLLINS, CANDACE JEANINE
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:JEANINE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3638
Mailing Address - Country:US
Mailing Address - Phone:773-343-3060
Mailing Address - Fax:
Practice Address - Street 1:925 E 46TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3638
Practice Address - Country:US
Practice Address - Phone:773-343-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor