Healthcare Provider Details

I. General information

NPI: 1609780659
Provider Name (Legal Business Name): CANDIS LEIGH ROBERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 N WARREN AVE
SAGINAW MI
48607-1548
US

IV. Provider business mailing address

128 N WARREN AVE
SAGINAW MI
48607-1548
US

V. Phone/Fax

Practice location:
  • Phone: 989-754-8598
  • Fax: 989-754-5754
Mailing address:
  • Phone: 989-754-8598
  • Fax: 989-754-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: