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General NPI Number Information
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NPI Number | 1194134072
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Entity Type | Individual
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Provider Name | CANDACE P GARDNER LMT
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Gender | Female
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 960 DIECKMAN ST
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City | WOODSTOCK
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State | IL
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Zip | 60098-9287
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Country | US
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Telephone | 815-404-1185
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Fax |
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Provider Business Mailing Address
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Address Line | 1060 CASTLESHIRE DR
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City | WOODSTOCK
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State | IL
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Zip | 60098-3164
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Country | US
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Telephone | 815-404-1185
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227.016782
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198001435
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License Number State | IL
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