Individual
KARSON KANANI BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
219 42ND ST, SPRINGFIELD, OR 97478-5937
(541) 224-6897
Mailing address
5869 WILSHIRE DR, FONTANA, CA 92336-5696
(909) 434-6695
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/19/2023
Last updated
01/19/2023
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