Individual
JENNIE BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1519 N MAIN ST # 110, MERIDIAN, ID 83642-1717
(208) 724-8284
Mailing address
1628 S LOGGERS POND PL APT 13, BOISE, ID 83706-6599
(208) 724-8284
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC-8077
ID
Other
Enumeration date
01/17/2023
Last updated
01/17/2023
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