Healthcare Provider Details

I. General information

NPI: 1497903330
Provider Name (Legal Business Name): JODI JAYE LEEKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 HWY V V
KENNETT MO
63857-0071
US

IV. Provider business mailing address

925 HWY V V
KENNETT MO
63857-0071
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-5925
  • Fax: 573-888-9365
Mailing address:
  • Phone: 573-888-5925
  • Fax: 573-888-9365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2345-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: