Provider Demographics
NPI:1538048319
Name:PETERS, CANDYCE MARIE
Entity type:Individual
Prefix:
First Name:CANDYCE
Middle Name:MARIE
Last Name:PETERS
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 1:31 DOUBLETREE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-9143
Mailing Address - Country:US
Mailing Address - Phone:307-709-0341
Mailing Address - Fax:
Practice Address - Street 1:31 DOUBLETREE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-9143
Practice Address - Country:US
Practice Address - Phone:307-709-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services