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1912363375
JAY ALAN BASTIAN
FORT WAYNE, IN
NPI
1912363375
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
104100000X Social Worker
(Licence: IN 33007337A)
Enumeration Date
2016-01-14
Last Update Date
2024-10-15
Business Address
JAY ALAN BASTIAN LCSW
9329 ILLINOIS RD
FORT WAYNE, IN 46804-5796
Phone number: 260-418-9653
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Mailing Address
JAY ALAN BASTIAN LCSW
9329 ILLINOIS RD
FORT WAYNE, IN 46804-5796
Phone number: 260-418-9653
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