Healthcare Provider Details

I. General information

NPI: 1639719321
Provider Name (Legal Business Name): JODI LEIB CODEN MA, RDT, CATP, CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JODI RACHELLE LEIB MA, RDT, CATP, CDP

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 W BIG BEAVER RD STE 780
TROY MI
48084-4745
US

IV. Provider business mailing address

6725 DALY RD UNIT 251952
WEST BLOOMFIELD MI
48325-3280
US

V. Phone/Fax

Practice location:
  • Phone: 248-880-6600
  • Fax: 248-817-8458
Mailing address:
  • Phone: 248-880-6600
  • Fax: 248-817-8458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number6352000923
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: