Individual
MR. JESSE BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
18303 E 10 MILE RD STE 200, ROSEVILLE, MI 48066-4989
(586) 745-0116
Mailing address
18303 E 10 MILE RD STE 200, ROSEVILLE, MI 48066-4989
(586) 745-0116
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801095708
MI
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
05/09/2013
Last updated
09/19/2018
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