Individual
MS. LISA K JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6763 PAGE AVE, SAINT LOUIS, MO 63133-1635
(314) 206-3700
Mailing address
1430 OLIVE ST STE 400, SAINT LOUIS, MO 63103-2303
(314) 362-3700
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2011041574
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2011041574
LCSW
MO
Enumeration date
05/17/2018
Last updated
05/17/2018
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