Provider Demographics
NPI:1174794192
Name:ODOM, CANDICE BOURGEOIS (MS, CCC/A)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:BOURGEOIS
Last Name:ODOM
Suffix:
Gender:F
Credentials:MS, CCC/A
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:BOURGEOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/A
Mailing Address - Street 1:10740 N GESSNER DR
Mailing Address - Street 2:STE 310
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:281-890-8890
Practice Address - Street 1:18648 MCKAY DR
Practice Address - Street 2:SUITE 120
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5723
Practice Address - Country:US
Practice Address - Phone:281-548-2626
Practice Address - Fax:281-548-1659
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51570237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00644397Medicare PIN
TX8K8211Medicare PIN
TX8K5752Medicare PIN