Individual
MRS. NANCY BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
928 E WAYNE ST, SUITE C, SOUTH BEND, IN 46617-3024
(574) 286-0030
(574) 234-1994
Mailing address
53658 MARK DR, BRISTOL, IN 46507-9710
(574) 286-0030
(574) 234-1994
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34004946A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000373892
BLUE CROSS BLUE SHIELD
IN
Enumeration date
03/06/2007
Last updated
07/09/2007
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