Provider Demographics
NPI:1043088891
Name:LEEDER, JENNIFER C (PSYD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:LEEDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 NORTHBROOKE PLAZA DR STE 307
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8102
Mailing Address - Country:US
Mailing Address - Phone:239-963-4367
Mailing Address - Fax:
Practice Address - Street 1:2590 NORTHBROOKE PLAZA DR STE 307
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8102
Practice Address - Country:US
Practice Address - Phone:239-963-4367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health