Bacon, Jessie A
Bacon, Jessie A is an sole proprietor health care provider with primary practice located at Mission Road Blding 248 Fort Hall Indian Agency, Fort Hall ID 83203. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Bacon, Jessie A can be contacted via phone (208) 237-5631.Contact Information
Primary practice address
Mission Road Blding 248 Fort Hall Indian Agency
Fort Hall ID 83203
Phone: (208) 237-5631
Fax: (208) 237-5796
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Behavioral Health & Social Service Providers / Clinical | 1041C0700X | LCSW-32218 | Idaho |
Profile Details
NPI number | 1750507604 |
---|---|
LBN Legal business name | Bacon, Jessie A |
Credentials | Licensed Clinical Social Worker (LCSW) |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Apr 18th, 2007 |
Last updated | Mar 18th, 2024 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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