Healthcare Provider Details

I. General information

NPI: 1720918253
Provider Name (Legal Business Name): HEATHER REBECCA BACON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 K ST NW STE 300
WASHINGTON DC
20006-1631
US

IV. Provider business mailing address

9610 LOW MEADOW DR
GAITHERSBURG MD
20882-3032
US

V. Phone/Fax

Practice location:
  • Phone: 202-515-1993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLG200004846
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: