Provider Demographics
NPI:1063914273
Name:HIGDON, JON CLINTON (CSW, MSW)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:CLINTON
Last Name:HIGDON
Suffix:
Gender:M
Credentials:CSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10703 MCCAMISH RD
Mailing Address - Street 2:
Mailing Address - City:PHILPOT
Mailing Address - State:KY
Mailing Address - Zip Code:42366-9631
Mailing Address - Country:US
Mailing Address - Phone:270-925-1402
Mailing Address - Fax:
Practice Address - Street 1:1326 W 9TH ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-2028
Practice Address - Country:US
Practice Address - Phone:270-240-1076
Practice Address - Fax:270-240-2154
Is Sole Proprietor?:No
Enumeration Date:2018-03-03
Last Update Date:2018-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252497104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker