Basic Information
| Provider Information | |||||||||
| NPI: | 1467431619 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FIELDER | ||||||||
| FirstName: | CANDACE | ||||||||
| MiddleName: | JOAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LSCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 210 W 21ST ST | ||||||||
| Address2: | |||||||||
| City: | CONCORDIA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 669015200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327471400 | ||||||||
| FaxNumber: | 7327471400 | ||||||||
| Practice Location | |||||||||
| Address1: | 1836 M ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 669352206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855272549 | ||||||||
| FaxNumber: | 7855874377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2006 | ||||||||
| LastUpdateDate: | 04/04/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 44SC05900266 | NJ | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 4139 | KS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.