Healthcare Provider Details

I. General information

NPI: 1902078116
Provider Name (Legal Business Name): CANDACE SUH PETERSON MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDACE SUH CRESSMAN MS

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S CEDAR CREST BLVD
ALLENTOWN PA
18103-6369
US

IV. Provider business mailing address

1240 S CEDAR CREST BLVD
ALLENTOWN PA
18103-6369
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-9672
  • Fax: 610-402-2754
Mailing address:
  • Phone: 610-402-9672
  • Fax: 610-402-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number2005219
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: