Basic Information
| Provider Information | |||||||||
| NPI: | 1699209643 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEAFBLAD | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 10TH ST W | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551021062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512323901 | ||||||||
| FaxNumber: | 6513263521 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 UNIVERSITY AVE W FL 6 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551043727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512322273 | ||||||||
| FaxNumber: | 6512324953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 21823 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.