Provider Demographics
NPI:1861128134
Name:DOTSON, CANDICE RENEE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:RENEE
Last Name:DOTSON
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 1:210 PERSIMMON DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-1291
Mailing Address - Country:US
Mailing Address - Phone:281-543-9858
Mailing Address - Fax:
Practice Address - Street 1:4544 INTERSTATE 10 E
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-8881
Practice Address - Country:US
Practice Address - Phone:281-420-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100858235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist