Provider Demographics
NPI:1063697845
Name:BOLDEN, CANDIS ANN (MS/CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CANDIS
Middle Name:ANN
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:MISS
Other - First Name:CANDIS
Other - Middle Name:ANN
Other - Last Name:ROCHNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1827
Mailing Address - Country:US
Mailing Address - Phone:978-921-1182
Mailing Address - Fax:
Practice Address - Street 1:111 DODGE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1827
Practice Address - Country:US
Practice Address - Phone:978-921-1182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-30
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2881235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist