MEDICARE: ALYSSA BACON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	134382-121	WI
2	104100000X	Social Worker	134382-121	WI

General Provider Information

NPI Number	:	1225717945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA BACON

Provider Business Mailing Address
First Line	:	1419 E ALBION ST APT 1
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2335
Country	:	US
Telephone Number	:	727-514-2461
Fax Number	:

Provider Business Practice Location Address
First Line	:	7280 S 13TH ST STE 202
Second Line	:
City	:	OAK CREEK
State	:	WI
Zip	:	53154-1831
Country	:	US
Telephone Number	:	414-929-5929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2023
Last Update Date	:	01/06/2026

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Directions to “ ALYSSA BACON ” Practice Location

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