MEDICARE: JODI LEAL IADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	15020	IA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255578233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI LEAL IADC

Provider Business Mailing Address
First Line	:	320 N EISENHOWER AVE
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-1521
Country	:	US
Telephone Number	:	641-243-7232
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 N EISENHOWER AVE
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-1521
Country	:	US
Telephone Number	:	641-243-7232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	01/24/2022

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Directions to “ JODI LEAL IADC” Practice Location

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