Provider Demographics
NPI:1245588466
Name:MCCONNELL, AUDRA J (LCSW)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:J
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:J
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2885 W BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3952
Mailing Address - Country:US
Mailing Address - Phone:417-761-5000
Mailing Address - Fax:
Practice Address - Street 1:1423 N JEFFERSON AVE FL 3
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-1917
Practice Address - Country:US
Practice Address - Phone:417-761-5000
Practice Address - Fax:417-761-5000
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120181591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO440552485OtherTRICARE
MO1245588466Medicaid
MO1245588466Medicaid