JESSIE A BACON LCSW
Individual Provider (NPI-1)
Active
Social Worker, Clinical
Provider Information
- NPI Number
1750507604- Provider Type
- Individual Provider (NPI-1)
- Credentials
- LCSW
- Status
- Active
Contact & Location
- Address
- MISSION ROAD BLDING 248 FORT HALL INDIAN AGENCY, FORT HALL, ID, 83203
- Phone
- (208) 237-5631
- Fax
- (208) 237-5796
Specialties & Taxonomies
Social Worker, Clinical
Primary License: ID #LCSW-32218