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General NPI Number Information
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NPI Number | 1184242885
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Entity Type | Individual
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Provider Name | JODI LEIRNESS PSYD, LP
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Gender | Female
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 370 SELBY AVE STE 316
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City | SAINT PAUL
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State | MN
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Zip | 55102-1965
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Country | US
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Telephone | 651-300-1729
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Fax |
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Provider Business Mailing Address
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Address Line | 5536 DUPONT AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55419-1648
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Country | US
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Telephone | 651-253-3054
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LP5948
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License Number State | MN
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