MEDICARE: CANDICE UPHAM MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP776	AZ
2	235Z00000X	Speech-Language Pathologist	24427871	CO

General Provider Information

NPI Number	:	1730442112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE UPHAM MS, CCC-SLP

Provider Business Mailing Address
First Line	:	5650 ASTORIA WAY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-5401
Country	:	US
Telephone Number	:	480-277-3563
Fax Number	:

Provider Business Practice Location Address
First Line	:	5650 ASTORIA WAY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-5401
Country	:	US
Telephone Number	:	480-277-3563
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	05/07/2024

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Directions to “ CANDICE UPHAM MS, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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