Provider Demographics
NPI:1730442112
Name:UPHAM, CANDICE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:UPHAM
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 1:5650 ASTORIA WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-5401
Mailing Address - Country:US
Mailing Address - Phone:480-277-3563
Mailing Address - Fax:
Practice Address - Street 1:5650 ASTORIA WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-5401
Practice Address - Country:US
Practice Address - Phone:480-277-3563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP776235Z00000X
CO24427871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist