Individual
DR. KRISTA BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4001 MAIN ST STE 218, VANCOUVER, WA 98663-1888
(360) 777-6915
Mailing address
4001 MAIN STREET, SUITE 218, BOX 7, VANCOUVER, WA 98663-1888
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
PY61395594
WA
103TF0200X
Forensic Psychologist
Primary
PY61395594
WA
Other
Enumeration date
09/21/2015
Last updated
09/18/2023
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