Provider Demographics
NPI:1114312279
Name:LUDWIG, JOSEPHINE (RPH,MA,LPC)
Entity Type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:RPH,MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10176 CORPORATE SQUARE DR
Mailing Address - Street 2:SUITE 100S
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2924
Mailing Address - Country:US
Mailing Address - Phone:314-805-1702
Mailing Address - Fax:
Practice Address - Street 1:10176 CORPORATE SQUARE DR
Practice Address - Street 2:SUITE 100S
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-2924
Practice Address - Country:US
Practice Address - Phone:314-805-1702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-04
Last Update Date:2015-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012008191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health