Healthcare Provider Details

I. General information

NPI: 1194134072
Provider Name (Legal Business Name): CANDACE P GARDNER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 DIECKMAN ST
WOODSTOCK IL
60098-9287
US

IV. Provider business mailing address

1060 CASTLESHIRE DR
WOODSTOCK IL
60098-3164
US

V. Phone/Fax

Practice location:
  • Phone: 815-404-1185
  • Fax:
Mailing address:
  • Phone: 815-404-1185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198001435
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.016782
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: