Individual
MR. DEL GENE BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
645 3RD AVE SW, PINE CITY, MN 55063-1468
(320) 629-1362
(320) 629-3454
Mailing address
2085 DOTTE DR, #103, WHITE BEAR LAKE, MN 55110-4369
(320) 629-1362
(320) 629-3454
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302602
MN
Other
Enumeration date
04/13/2011
Last updated
04/13/2011
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