Individual
STACY BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1701 18TH AVE S, SEATTLE, WA 98144-4317
(253) 833-7444
Mailing address
1412 140TH PL NE, BELLEVUE, WA 98007-3915
(209) 733-0708
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO60251849
WA
Other
Enumeration date
05/22/2019
Last updated
12/30/2021
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