MEDICARE: CHRISTINE BACON SLP

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	235Z00000X	Speech-Language Pathologist	3840

General Provider Information

NPI Number	:	1295439552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE BACON SLP

Provider Business Mailing Address
First Line	:	540 COAKLEY DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95117-1522
Country	:	US
Telephone Number	:	408-921-6863
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 COAKLEY DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95117-1522
Country	:	US
Telephone Number	:	408-921-6863
Fax Number	:

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

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	03/29/2023

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Directions to “ CHRISTINE BACON SLP” Practice Location

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