Provider Demographics
NPI:1992484026
Name:JOHNSON, AUNDREA DENISE (PLPC)
Entity type:Individual
Prefix:MRS
First Name:AUNDREA
Middle Name:DENISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11955 RED BARN CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-7830
Mailing Address - Country:US
Mailing Address - Phone:314-791-1569
Mailing Address - Fax:
Practice Address - Street 1:11520 SAINT CHARLES ROCK RD STE 205
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2732
Practice Address - Country:US
Practice Address - Phone:314-252-8216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YS0200X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool