Individual
BRYANT VETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
20036 BADGER RD, BEND, OR 97702-2570
(541) 200-0603
Mailing address
20036 BADGER RD, BEND, OR 97702-2570
(541) 200-0603
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
6301009409
MI
1041C0700X
Clinical Social Worker
6801074389
MI
1041C0700X
Clinical Social Worker
Primary
L6141
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2015165
CIGNA #
MI
Enumeration date
06/03/2006
Last updated
04/22/2021
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