Healthcare Provider Details

I. General information

NPI: 1992484026
Provider Name (Legal Business Name): AUNDREA DENISE JOHNSON PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11520 SAINT CHARLES ROCK RD STE 205
BRIDGETON MO
63044-2732
US

IV. Provider business mailing address

11955 RED BARN CT
FLORISSANT MO
63033-7830
US

V. Phone/Fax

Practice location:
  • Phone: 314-252-8216
  • Fax:
Mailing address:
  • Phone: 314-791-1569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: