Individual
MISS MCKAYLA BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1135 N H ST, BROKEN BOW, NE 68822-1262
(308) 872-2982
Mailing address
323 N 7TH AVE, BROKEN BOW, NE 68822-1718
(308) 872-6821
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
—
Other
Enumeration date
07/12/2023
Last updated
07/12/2023
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