Healthcare Provider Details

I. General information

NPI: 1639248461
Provider Name (Legal Business Name): LEAH JANE HOLMES M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 VIKING DR NW
ROCHESTER MN
55901-2460
US

IV. Provider business mailing address

1805 7TH ST SW
ROCHESTER MN
55902-0915
US

V. Phone/Fax

Practice location:
  • Phone: 507-281-6240
  • Fax: 507-281-6247
Mailing address:
  • Phone: 507-287-8143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberLP2266
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP2266
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberLP2266
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP2266
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: