Healthcare Provider Details

I. General information

NPI: 1366011983
Provider Name (Legal Business Name): JOANNA R BRODERSEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA STRUTTMAN LPC

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 HIGHWAY KK
PLEASANT HOPE MO
65725-8100
US

IV. Provider business mailing address

1970 HIGHWAY KK
PLEASANT HOPE MO
65725-8100
US

V. Phone/Fax

Practice location:
  • Phone: 417-221-6655
  • Fax:
Mailing address:
  • Phone: 417-221-6655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2021030516
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2021030516
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC8553
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: