Jessie A Bacon, LCSW

NPI #1750507604 in Fort Hall, Idaho

Provider Information

NPI Number: 1750507604
Entity Type: Individual
Name: Jessie A Bacon, LCSW
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Social Worker - Clinical
Credential: LCSW
Enumeration Date: Apr 18, 2007
Last Updated: Mar 18, 2024

Practice Location

Address: MISSION ROAD BLDING 248
Address 2: FORT HALL INDIAN AGENCY
City: Fort Hall
State: Idaho
ZIP Code: 83203
Phone: (208) 237-5631

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X	Primary

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