Healthcare Provider Details

I. General information

NPI: 1750220364
Provider Name (Legal Business Name): JONATHON POFFENBARGER LMSW-T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 STATE ST
FORT SCOTT KS
66701-2031
US

IV. Provider business mailing address

1106 S 9TH ST
HUMBOLDT KS
66748-1934
US

V. Phone/Fax

Practice location:
  • Phone: 620-223-1650
  • Fax:
Mailing address:
  • Phone: 620-473-2241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14995-T
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: