Healthcare Provider Details

I. General information

NPI: 1568389666
Provider Name (Legal Business Name): MADGE MCCOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 SHEIDLEY AVE STE 200
BONNER SPRINGS KS
66012-1825
US

IV. Provider business mailing address

10875 GRANDVIEW DR STE 2200
OVERLAND PARK KS
66210-1510
US

V. Phone/Fax

Practice location:
  • Phone: 913-257-3047
  • Fax:
Mailing address:
  • Phone: 913-257-3047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: