Healthcare Provider Details

I. General information

NPI: 1609502285
Provider Name (Legal Business Name): KANDASCE HAIR PROFESSIONALS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17513 KEDZIE AVE
HAZEL CREST IL
60429-2007
US

IV. Provider business mailing address

17513 KEDZIE AVE
HAZEL CREST IL
60429-2007
US

V. Phone/Fax

Practice location:
  • Phone: 708-407-0154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. CANDACE THOMAS PERTEET
Title or Position: PRESIDENT
Credential:
Phone: 708-407-0154