Healthcare Provider Details

I. General information

NPI: 1639880719
Provider Name (Legal Business Name): CANDACE ANN-MARIE HUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDACE ANN-MARIE GELFAND

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 BENTON DR BLDG C
REDDING CA
96003-5349
US

IV. Provider business mailing address

2280 BENTON DR BLDG C
REDDING CA
96003-5349
US

V. Phone/Fax

Practice location:
  • Phone: 530-242-2020
  • Fax: 530-241-2121
Mailing address:
  • Phone: 530-242-2020
  • Fax: 530-241-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: