Healthcare Provider Details

I. General information

NPI: 1538004643
Provider Name (Legal Business Name): CANDICE COLE SLP-ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N CHURCH ST
MONROE NC
28112-4804
US

IV. Provider business mailing address

2517 SIERRA CHASE DR
MONROE NC
28112-7623
US

V. Phone/Fax

Practice location:
  • Phone: 704-296-9898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number01020
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: