Provider Demographics
NPI:1356302251
Name:STERN-TUOMALA, LEONA ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:ANN
Last Name:STERN-TUOMALA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LEONA
Other - Middle Name:ANN
Other - Last Name:SELZLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:69 EXCHANGE ST W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1004
Mailing Address - Country:US
Mailing Address - Phone:651-232-3640
Mailing Address - Fax:651-232-3632
Practice Address - Street 1:69 EXCHANGE ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1004
Practice Address - Country:US
Practice Address - Phone:651-232-3640
Practice Address - Fax:651-232-3632
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN99361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP90790Medicare UPIN