Provider Demographics
NPI:1104615665
Name:BROWN, CANDACE (EDD)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:
Last Name:BROWN
Suffix:
Gender:
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9333 S HARLEM AVE APT 6B
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2089
Mailing Address - Country:US
Mailing Address - Phone:312-804-2662
Mailing Address - Fax:
Practice Address - Street 1:9333 S HARLEM AVE APT 6B
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2089
Practice Address - Country:US
Practice Address - Phone:312-804-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency