Provider Demographics
NPI:1265505580
Name:WOHLDMANN, ROGER ROBERT (LPC, CASAC)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:ROBERT
Last Name:WOHLDMANN
Suffix:
Gender:M
Credentials:LPC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2814
Mailing Address - Country:US
Mailing Address - Phone:314-703-2721
Mailing Address - Fax:
Practice Address - Street 1:214 CHURCH ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2814
Practice Address - Country:US
Practice Address - Phone:314-703-2721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999143405101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor