Individual
JESSIE A BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
MISSION ROAD BLDING 248, FORT HALL INDIAN AGENCY, FORT HALL, ID 83203
(208) 237-5631
(208) 237-5796
Mailing address
1068 E RESERVATION RICH LN, BLACKFOOT, ID 83221-7052
(208) 681-6980
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-32218
ID
Other
Enumeration date
04/18/2007
Last updated
03/18/2024
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