Provider Demographics
NPI:1770776478
Name:STAED, CANDACE JENNETTE (MS)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:JENNETTE
Last Name:STAED
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 19TH ST S
Mailing Address - Street 2:SRC RO44
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35249-1900
Mailing Address - Country:US
Mailing Address - Phone:205-934-4816
Mailing Address - Fax:205-934-7420
Practice Address - Street 1:RO44 SPAIN REHABILITATION CENTER
Practice Address - Street 2:1717 6TH AVENUE SOUTH
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-0001
Practice Address - Country:US
Practice Address - Phone:205-934-4816
Practice Address - Fax:205-934-7420
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-25
Last Update Date:2007-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0966A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist