Provider Demographics
NPI:1932774940
Name:PAULSEN, CANDICE LAW (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:LAW
Last Name:PAULSEN
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 1:415 MEDICAL DR STE B102
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4989
Mailing Address - Country:US
Mailing Address - Phone:385-275-0492
Mailing Address - Fax:385-275-6764
Practice Address - Street 1:415 MEDICAL DR STE B102
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4989
Practice Address - Country:US
Practice Address - Phone:385-275-0492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1173588904102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist