Individual
GREGORY J BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
630 W KEARNEY ST, SPRINGFIELD, MO 65803-2508
(417) 761-5000
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
0000
MO
1041C0700X
Clinical Social Worker
Primary
2022030684
MO
1041C0700X
Clinical Social Worker
Primary
2026014312
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MO
Enumeration date
06/01/2022
Last updated
04/21/2026
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