Bethany Bacon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149017452 Issued in IL

Practice address

30 N Michigan Ave Ste 424
Chicago, IL 60602-3844

Phone

(312) 279-9981

NPI assigned

Feb 6, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mindbodycoop.bethanybacon@147350.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mind Body Co-Op

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
  • NPI 1750668091

  Clinical

  NPD
• Mind Body Co-Op

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
  • NPI 1770174559

  Clinical

  NPD
• Outreach Community Ministries Inc

  • Adolescent and Children Mental Health Clinic/Center
  • Wheaton, IL
  • NPI 1255443669

  Clinical

  NPD (past)
• Outreach Wheaton

  • Adolescent and Children Mental Health Clinic/Center
  • Wheaton, IL
  • NPI 1750948501

  Clinical

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787788800000",
    "number": "1184256232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N MICHIGAN AVE STE 424",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606023844",
            "telephone_number": "872-274-4344",
            "fax_number": "866-671-9991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N MICHIGAN AVE STE 424",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606023844",
            "telephone_number": "312-279-9981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "BETHANY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-06",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149017452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MindBodyCoop.bethanybacon@147350.advancedmd-direct.com",
            "affiliation": "N",
            "endpointDescription": "amd",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "30 N Michigan Ave Ste 424",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606023844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Backstrom Acupuncture LLC
• Hona Backstrom, LAC
• Justin Faivre Backstrom, DC
• Jessica Backus
• Olga Baclay, PT
• Kathryn S Bacon, RN
• Mary J Bacon, M.A., CCC-SLP
• Jonathan Bacos, STUDENT
• Nicholas Bacos
• Peter J Bacos, DDS

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.