Healthcare Provider Details

I. General information

NPI: 1023738234
Provider Name (Legal Business Name): LEIA LYNN TWIGG-SMITH PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 VETERANS DR
SAINT CLOUD MN
56303-2015
US

IV. Provider business mailing address

7423 RIVER BEND CT
SAUK RAPIDS MN
56379-9327
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-1670
  • Fax:
Mailing address:
  • Phone: 808-265-4448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberLP6822
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: