Provider Demographics
NPI:1124310107
Name:WAWRA, CANDACE
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:WAWRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E WOODHURST DR
Mailing Address - Street 2:SUITE Q BUILDING 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4261
Mailing Address - Country:US
Mailing Address - Phone:417-881-1010
Mailing Address - Fax:417-887-4327
Practice Address - Street 1:1200 E WOODHURST DR
Practice Address - Street 2:SUITE Q BUILDING 100
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4261
Practice Address - Country:US
Practice Address - Phone:417-881-1010
Practice Address - Fax:417-887-4327
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009005827237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist