Active NPI
Rachel Evelyn Bacon, LCSW
- Clinical Social Worker
- Milwaukee, WI
National Provider Identifier
1649840786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 9709-123
- Practice address
- 3732 W Wisconsin Ave Ste 320
Milwaukee, WI 53208-3166 - Phone
- (414) 290-0400
- NPI assigned
- Jun 30, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 9709-123 | WI | Primary |
Addresses
Primary practice location
3732 W Wisconsin Ave Ste 320
Milwaukee, WI 53208-3166
Mailing address
3732 W Wisconsin Ave Ste 320
Milwaukee, WI 53208-3166
Phone (414) 290-0400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9709-123 | Other | WI | DSPS |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9709-123 | WI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625011200000",
"number": "1649840786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3732 W WISCONSIN AVE STE 320",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532083166",
"telephone_number": "414-290-0400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3732 W WISCONSIN AVE STE 320",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532083166",
"telephone_number": "414-290-0400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACON",
"first_name": "RACHEL",
"middle_name": "EVELYN",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-30",
"last_updated": "2021-06-30",
"certification_date": "2021-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "9709-123",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DSPS",
"identifier": "9709-123",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.