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General NPI Number Information
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NPI Number | 1770769259
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Entity Type | Individual
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Provider Name | CONSTANCE BACH M.S., MT-BC
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Gender | Female
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 1213 E BRONSON ST
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City | SOUTH BEND
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State | IN
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Zip | 46615-1141
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Country | US
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Telephone | 574-287-8342
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Fax |
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Provider Business Mailing Address
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Address Line | 1213 E BRONSON ST
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City | SOUTH BEND
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State | IN
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Zip | 46615-1141
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Country | US
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Telephone | 574-287-8342
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 08208
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License Number State | IN
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