Provider Demographics
NPI:1750505996
Name:GULANICK, NANCY ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ANNE
Last Name:GULANICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1295
Mailing Address - Country:US
Mailing Address - Phone:574-287-7399
Mailing Address - Fax:574-287-8484
Practice Address - Street 1:300 N MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1295
Practice Address - Country:US
Practice Address - Phone:574-287-7399
Practice Address - Fax:574-287-8484
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010342A103T00000X, 103TC0700X, 103TC1900X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20010342AOtherPSYCHOLOGIST LICENSE #
IN200400Medicare ID - Type UnspecifiedPSYCHOLOGIST