MEDICARE: MRS. JODI JAYE LEEKER LCSW

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	104100000X	Social Worker	2345-C	AR

General Provider Information

NPI Number	:	1497903330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JODI JAYE LEEKER LCSW

Provider Business Mailing Address
First Line	:	925 HWY V V
Second Line	:
City	:	KENNETT
State	:	MO
Zip	:	63857-0071
Country	:	US
Telephone Number	:	573-888-5925
Fax Number	:	573-888-9365

Provider Business Practice Location Address
First Line	:	925 HWY V V
Second Line	:
City	:	KENNETT
State	:	MO
Zip	:	63857-0071
Country	:	US
Telephone Number	:	573-888-5925
Fax Number	:	573-888-9365

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

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	09/18/2014

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