MEDICARE: CANDACE HARGRAVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		IL

General Provider Information

NPI Number	:	1114878121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE HARGRAVE

Provider Business Mailing Address
First Line	:	14842 S LASALLE STREET
Second Line	:
City	:	DOLTON
State	:	IL
Zip	:	60419
Country	:	US
Telephone Number	:	708-224-3117
Fax Number	:

Provider Business Practice Location Address
First Line	:	14842 S LASALLE STREET
Second Line	:
City	:	DOLTON
State	:	IL
Zip	:	60419
Country	:	US
Telephone Number	:	708-224-3117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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Directions to “ CANDACE HARGRAVE ” Practice Location

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