| Doctor Name: | MS. JILL E BACON |
| NPI Number: | 1770704041 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | |
| Business Practice Address: | 35888 Center Ridge Road Suite 5 North Ridgeville, OH - 44039 |
| Business Phone Number: | 4403271800 |
| Business Fax Number: | 4403271533 |
| Mailing Address: | 35888 Center Ridge Road, Suite 5 NORTH RIDGEVILLE |
| State: | OH |
| Postal Code: | 44039 |
| Phone Number: | 4403271800 |
| Fax Number: | 4403271533 |
| NPI Enumeration Date: | 05/02/2007 |
| NPI Last Update Date: | 06/01/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |