Active NPI
Jaime Lee Bacon, LCSW
- Clinical Social Worker
- Saint George, UT
National Provider Identifier
1376758342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 361006-3501
- Practice address
- 230 N 1680 E
Ste T2
Saint George, UT 84790-2573 - Phone
- (435) 652-2114
- Fax
- (435) 652-2132
- NPI assigned
- May 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 361006-3501 | UT | Primary |
| Clinical Social Worker | 1041C0700X | LCSW-11011 | AZ |
Addresses
Primary practice location
230 N 1680 E
Ste T2
Saint George, UT 84790-2573
Mailing address
230 N 1680 E
Ste T2
Saint George, UT 84790-2573
Phone (435) 652-2114
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW-11011 | AZ | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1504224000000",
"number": "1376758342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 N 1680 E",
"address_2": "STE T2",
"city": "SAINT GEORGE",
"state": "UT",
"postal_code": "847902573",
"telephone_number": "435-652-2114",
"fax_number": "435-652-2132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 N 1680 E",
"address_2": "STE T2",
"city": "SAINT GEORGE",
"state": "UT",
"postal_code": "847902573",
"telephone_number": "435-652-2114",
"fax_number": "435-652-2132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACON",
"first_name": "JAIME",
"middle_name": "LEE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-13",
"last_updated": "2017-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "361006-3501",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AZ",
"license": "LCSW-11011",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint George, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.