Provider Demographics
NPI:1396353694
Name:BACON, VICTORIA ANNE (MS, MPH)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANNE
Last Name:BACON
Suffix:
Gender:F
Credentials:MS, MPH
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:ANNE
Other - Last Name:HARBESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 CASTLEGATE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-4415
Mailing Address - Country:US
Mailing Address - Phone:661-435-6451
Mailing Address - Fax:
Practice Address - Street 1:300 HALKET ST STE 1651
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3108
Practice Address - Country:US
Practice Address - Phone:412-641-7131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPGC000116170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS