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Individual

JAY ALAN BASTIAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
9329 ILLINOIS RD, FORT WAYNE, IN 46804-5796
(260) 418-9653
Mailing address
9329 ILLINOIS RD, FORT WAYNE, IN 46804-5796
(260) 418-9653

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
33007337A
IN

Other

Enumeration date
01/14/2016
Last updated
10/15/2024
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