Provider Demographics
NPI:1437466869
Name:COWHERD, KANDICE L
Entity type:Individual
Prefix:
First Name:KANDICE
Middle Name:L
Last Name:COWHERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KANDICE
Other - Middle Name:L
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21479 E PECAN LN
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5452
Mailing Address - Country:US
Mailing Address - Phone:971-713-4455
Mailing Address - Fax:
Practice Address - Street 1:21479 E PECAN LN
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5452
Practice Address - Country:US
Practice Address - Phone:971-713-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-07026104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker