Individual
SHALYNN GRACE BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
Mailing address
2625 MEDFORD DR, FORT WAYNE, IN 46803-3132
(260) 426-5431
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
33008506A
IN
Other
Enumeration date
11/24/2019
Last updated
08/20/2021
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