Provider Demographics
NPI:1497597462
Name:CANDANOZA, MIRANDA K (SLP-ASSISTANT)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:K
Last Name:CANDANOZA
Suffix:
Gender:F
Credentials:SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13333 BLANCO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2138
Mailing Address - Country:US
Mailing Address - Phone:210-479-5875
Mailing Address - Fax:210-479-2911
Practice Address - Street 1:13333 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2138
Practice Address - Country:US
Practice Address - Phone:210-479-5875
Practice Address - Fax:210-479-2911
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX433872355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant