Healthcare Provider Details

I. General information

NPI: 1396221636
Provider Name (Legal Business Name): CANDACE R DELIS LPC, LPCC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 7TH ST S
WISCONSIN RAPIDS WI
54494-6003
US

IV. Provider business mailing address

1910 7TH ST S
WISCONSIN RAPIDS WI
54494-6003
US

V. Phone/Fax

Practice location:
  • Phone: 715-441-1960
  • Fax:
Mailing address:
  • Phone: 715-697-4928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8026125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number110339
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8026-125
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number61485659
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: