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General NPI Number Information
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NPI Number | 1710785597
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Entity Type | Individual
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Provider Name | HALEY ANN BACON
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Gender | Female
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Dates
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Enumeration Date | 03/06/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 4840 GRASSELLI ST
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City | EAST CHICAGO
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State | IN
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Zip | 46312-3503
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Country | US
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Telephone | 219-397-1085
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 W MAIN ST
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City | GRIFFITH
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State | IN
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Zip | 46319-2620
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Country | US
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Telephone | 219-765-2242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-25-16388
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-305690
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License Number State | TN
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