Healthcare Provider Details

I. General information

NPI: 1710815600
Provider Name (Legal Business Name): PATRICIA K LEACH LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 PARK AVE
MINNEAPOLIS MN
55404-3713
US

IV. Provider business mailing address

1229 ROSE VISTA CT APT 4
ROSEVILLE MN
55113-6282
US

V. Phone/Fax

Practice location:
  • Phone: 888-881-8261
  • Fax: 320-316-2088
Mailing address:
  • Phone: 612-715-1236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31434
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: