Provider Demographics
NPI:1790344158
Name:LEECH, JACQUELYN OLSON (TLMHC)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:OLSON
Last Name:LEECH
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:ANN
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBSW
Mailing Address - Street 1:1622 LAKEVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327
Mailing Address - Country:US
Mailing Address - Phone:515-564-9071
Mailing Address - Fax:
Practice Address - Street 1:2301 W. 1ST STREET
Practice Address - Street 2:STE 4
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023
Practice Address - Country:US
Practice Address - Phone:515-508-1150
Practice Address - Fax:515-964-0106
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093303101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health