MEDICARE: CANDYCE LOUISE PHILLIPS

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	1041C0700X	Clinical Social Worker	129716-121	WI

General Provider Information

NPI Number	:	1588115919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDYCE LOUISE PHILLIPS

Provider Business Mailing Address
First Line	:	4232 W HIGHLAND BLVD APT 306
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-2780
Country	:	US
Telephone Number	:	414-469-4470
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 N HOLTON ST
Second Line	:	SUITE 400
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-1008
Country	:	US
Telephone Number	:	414-810-1535
Fax Number	:

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

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	10/20/2016

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Directions to “ CANDYCE LOUISE PHILLIPS ” Practice Location

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