Healthcare Provider Details

I. General information

NPI: 1891694402
Provider Name (Legal Business Name): JON WHITCOMB
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2942 E BATTLEFIELD RD
SPRINGFIELD MO
65804-4016
US

IV. Provider business mailing address

2102 E REGENCY PL
SPRINGFIELD MO
65804-7532
US

V. Phone/Fax

Practice location:
  • Phone: 417-771-5305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: