Provider Demographics
NPI:1831461045
Name:DAVID, CANDICE
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:DAVID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3147
Mailing Address - Country:US
Mailing Address - Phone:509-925-1530
Mailing Address - Fax:
Practice Address - Street 1:502 N ANDERSON ST
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3147
Practice Address - Country:US
Practice Address - Phone:509-925-1530
Practice Address - Fax:509-925-1526
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60075522225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist