Provider Demographics
NPI:1770699944
Name:DEBBAN-ANDERSON, CANDACE LYNN (MA LCSW)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:LYNN
Last Name:DEBBAN-ANDERSON
Suffix:
Gender:F
Credentials:MA LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:W6144 AEROTECH DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-7503
Mailing Address - Country:US
Mailing Address - Phone:920-921-3343
Mailing Address - Fax:920-921-0989
Practice Address - Street 1:W6144 AEROTECH DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-7503
Practice Address - Country:US
Practice Address - Phone:920-921-3343
Practice Address - Fax:920-921-0989
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical