Provider Demographics
NPI:1396895884
Name:BACON, DANA MARGARET (LSW, MSW)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MARGARET
Last Name:BACON
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12278 KITTREDGE ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80603-6935
Mailing Address - Country:US
Mailing Address - Phone:720-934-6163
Mailing Address - Fax:
Practice Address - Street 1:5265 VANCE ST
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-3717
Practice Address - Country:US
Practice Address - Phone:720-934-6163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical