Healthcare Provider Details

I. General information

NPI: 1720593130
Provider Name (Legal Business Name): JESSICA LEINBERGER LPC-IT, SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 5TH AVE S STE 507
LA CROSSE WI
54601-4018
US

IV. Provider business mailing address

537 E JEFFERSON ST
VIROQUA WI
54665-1730
US

V. Phone/Fax

Practice location:
  • Phone: 608-797-5679
  • Fax:
Mailing address:
  • Phone: 608-632-2291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: