Provider Demographics
NPI:1871792325
Name:CANDLER, JENNIFER ANN (MHS, ITDS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:CANDLER
Suffix:
Gender:F
Credentials:MHS, ITDS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:GABLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:434 NW LAKE VALLEY TER
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-8526
Mailing Address - Country:US
Mailing Address - Phone:386-984-0409
Mailing Address - Fax:386-758-1676
Practice Address - Street 1:434 NW LAKE VALLEY TER
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-8526
Practice Address - Country:US
Practice Address - Phone:386-984-0409
Practice Address - Fax:386-758-1676
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-15
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist