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
Fax: (208) 237-5796
Website:

Health care specialties

SpecialtyCodeLicense #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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