Individual
BRYCE JACOB INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4609 GRAPE RD STE D1B, MISHAWAKA, IN 46545-8259
(574) 217-1624
Mailing address
5776 GRAPE RD, PMB 171, MISHAWAKA, IN 46545
(574) 217-1624
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-461824
IN
Other
Enumeration date
08/11/2025
Last updated
08/11/2025
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