Provider Demographics
NPI:1346261716
Name:KOHLER, CANDIDA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CANDIDA
Middle Name:
Last Name:KOHLER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 KENTON ST # NA
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-3111
Mailing Address - Country:US
Mailing Address - Phone:785-393-5147
Mailing Address - Fax:
Practice Address - Street 1:1719 KENTON ST # NA
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-3111
Practice Address - Country:US
Practice Address - Phone:785-393-5147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6037235Z00000X
MI7101007997235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887042000Medicaid