Provider Demographics
NPI:1588999106
Name:MCCOLLETT, CANDACE LYNN (CBE, CLD, CLE)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:LYNN
Last Name:MCCOLLETT
Suffix:
Gender:F
Credentials:CBE, CLD, CLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1563 CHESHAM CIRCLE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:719-213-3740
Mailing Address - Fax:719-264-1591
Practice Address - Street 1:1563 CHESHAM CIRCLE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-213-3740
Practice Address - Fax:719-264-1591
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6096374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula