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General NPI Number Information
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NPI Number | 1649134107
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Entity Type | Individual
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Provider Name | LELAND ROYAL JENSEN ADC-T
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Gender | Male
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 2532 N FERRY ST
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City | ANOKA
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State | MN
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Zip | 55303-1653
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Country | US
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Telephone | 763-452-7033
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Fax | 763-427-6084
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Provider Business Mailing Address
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Address Line | 2532 N FERRY ST
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City | ANOKA
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State | MN
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Zip | 55303-1653
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Country | US
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Telephone | 763-452-7033
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Fax | 612-823-4913
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3074
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License Number State | MN
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