Healthcare Provider Details

I. General information

NPI: 1255518148
Provider Name (Legal Business Name): LEANNE BETH TRUEDSON MSW, LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N ASH
HALLOCK MN
56728
US

IV. Provider business mailing address

510 PRAIRIE AVE. PO BOX 3
KENNEDY MN
56733-0003
US

V. Phone/Fax

Practice location:
  • Phone: 218-843-3682
  • Fax:
Mailing address:
  • Phone: 218-674-4405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number14216
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: