Provider Demographics
NPI:1528364049
Name:WHITCOMB, JOSHUA LEE
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:LEE
Last Name:WHITCOMB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1082 N 400 E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2302
Mailing Address - Country:US
Mailing Address - Phone:218-343-4765
Mailing Address - Fax:
Practice Address - Street 1:1115 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2217
Practice Address - Country:US
Practice Address - Phone:435-753-7053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker