Healthcare Provider Details

I. General information

NPI: 1629901509
Provider Name (Legal Business Name): JACQUELINE SUSAN LEINDECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 N ACADEMY BLVD
COLORADO SPRINGS CO
80918-4000
US

IV. Provider business mailing address

2106 MOUNT VERNON ST
COLORADO SPRINGS CO
80909-2820
US

V. Phone/Fax

Practice location:
  • Phone: 719-357-7504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0023928
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002990
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: