Provider Demographics
NPI:1740267202
Name:COOK, CANDACE ELENA (MS CCC SLP)
Entity type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:ELENA
Last Name:COOK
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6915 NORTHBURY LN
Mailing Address - Street 2:#926
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8676
Mailing Address - Country:US
Mailing Address - Phone:304-237-7087
Mailing Address - Fax:
Practice Address - Street 1:2675 COURT DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-1478
Practice Address - Country:US
Practice Address - Phone:704-824-4999
Practice Address - Fax:704-824-3999
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004811235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist