Provider Demographics
NPI:1750470159
Name:JOHNKE, DEBORAH SUE (MA LCSW LPC CASAC II)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:SUE
Last Name:JOHNKE
Suffix:
Gender:F
Credentials:MA LCSW LPC CASAC II
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:SUE
Other - Last Name:ROWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9962 LIN FERRY RD
Mailing Address - Street 2:STE 101
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123
Mailing Address - Country:US
Mailing Address - Phone:314-843-0303
Mailing Address - Fax:314-843-0087
Practice Address - Street 1:9962 LIN FERRY RD
Practice Address - Street 2:STE 101
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123
Practice Address - Country:US
Practice Address - Phone:314-843-0303
Practice Address - Fax:314-843-0087
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS001253101YM0800X
MOSW0020801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical