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Individual
SAMUEL BACON
Active
Individual
SAMUEL BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CG61384091
WA
106S00000X
Behavior Technician
—
—
Other
Enumeration date
10/17/2019
Last updated
12/16/2022
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