Provider Demographics
NPI:1043975816
Name:KROGER, CANDA (SLP ASSISTANT)
Entity type:Individual
Prefix:
First Name:CANDA
Middle Name:
Last Name:KROGER
Suffix:
Gender:
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 1:8605 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-2024
Mailing Address - Country:US
Mailing Address - Phone:214-695-6326
Mailing Address - Fax:
Practice Address - Street 1:1601 N COLLINS BLVD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3520
Practice Address - Country:US
Practice Address - Phone:972-470-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121627235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist