Provider Demographics
NPI:1902078116
Name:PETERSON, CANDACE SUH (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:SUH
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:MS
Other - First Name:CANDACE
Other - Middle Name:SUH
Other - Last Name:CRESSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1240 S CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6369
Mailing Address - Country:US
Mailing Address - Phone:610-402-9672
Mailing Address - Fax:610-402-2754
Practice Address - Street 1:1240 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6369
Practice Address - Country:US
Practice Address - Phone:610-402-9672
Practice Address - Fax:610-402-2754
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2005219170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS