Provider Demographics
NPI:1487760096
Name:MOLTZ, CANDACE C (MS, CCC)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:C
Last Name:MOLTZ
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:CANDY
Other - Middle Name:
Other - Last Name:MOLTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC
Mailing Address - Street 1:2431 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5459
Mailing Address - Country:US
Mailing Address - Phone:214-857-0951
Mailing Address - Fax:214-857-0999
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:ASPS (126)
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-0951
Practice Address - Fax:214-857-0999
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13344235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist