Provider Demographics
NPI:1528054871
Name:MCGINNIS, CANDY A (AUD)
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:A
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CANDY
Other - Middle Name:A
Other - Last Name:MCGINNIS-DAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1820 WEST POINTE DR.
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-4164
Mailing Address - Country:US
Mailing Address - Phone:920-233-1800
Mailing Address - Fax:920-232-1538
Practice Address - Street 1:1820 WEST POINTE DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4164
Practice Address - Country:US
Practice Address - Phone:920-233-1800
Practice Address - Fax:920-232-1538
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI200156237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1528054871OtherNPI
WI41126500Medicaid