Provider Demographics
NPI:1053098525
Name:MEESE, CANDACE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:MEESE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:800 W LONG LAKE RD STE 195
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2056
Mailing Address - Country:US
Mailing Address - Phone:248-214-7755
Mailing Address - Fax:248-940-2739
Practice Address - Street 1:800 W LONG LAKE RD STE 195
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-2056
Practice Address - Country:US
Practice Address - Phone:248-214-7755
Practice Address - Fax:248-940-2739
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005199235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist