Healthcare Provider Details

I. General information

NPI: 1518850221
Provider Name (Legal Business Name): KANDACE MINOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1552 S ROUTE 59
NAPERVILLE IL
60564-5941
US

IV. Provider business mailing address

1552 S ROUTE 59
NAPERVILLE IL
60564-5941
US

V. Phone/Fax

Practice location:
  • Phone: 815-585-6365
  • Fax:
Mailing address:
  • Phone: 773-914-2633
  • Fax: 773-914-2633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: