Individual
SAMANTHA RENEA BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
440 STUART RD NE STE 2, CLEVELAND, TN 37312-4959
(844) 244-1818
Mailing address
139 GALYON ST, SWEETWATER, TN 37874-5539
(865) 227-3898
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/01/2021
Last updated
12/01/2021
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