Provider Demographics
NPI:1508382383
Name:LEADER, JESSIE DAWN (LAMFT)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:DAWN
Last Name:LEADER
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 40TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2225
Mailing Address - Country:US
Mailing Address - Phone:612-296-4144
Mailing Address - Fax:
Practice Address - Street 1:3751 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1281
Practice Address - Country:US
Practice Address - Phone:612-605-3289
Practice Address - Fax:612-605-3289
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3477106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist