Healthcare Provider Details

I. General information

NPI: 1013560432
Provider Name (Legal Business Name): DANIELLE MARIE AUBUCHON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19515 BRUNE PKWY
WARRENTON MO
63383-6505
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 888-403-1071
  • Fax: 636-456-5014
Mailing address:
  • Phone: 660-885-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2021005173
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: