Individual
JUSTINE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2235 CLEVELAND RD, SOUTH BEND, IN 46628-3529
(574) 647-4530
(574) 647-2285
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-3725
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34009127A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300121318
—
IN
Enumeration date
11/14/2017
Last updated
01/04/2026
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