Individual
GAYLA BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7610 40TH ST W STE 300, UNIVERSITY PLACE, WA 98466-3834
(253) 307-5713
Mailing address
5410 N 44TH ST, TACOMA, WA 98407-3715
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/03/2007
Last updated
11/30/2018
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