Provider Demographics
NPI:1184242885
Name:LEIRNESS, JODI (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:
Last Name:LEIRNESS
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5536 DUPONT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1648
Mailing Address - Country:US
Mailing Address - Phone:651-253-3054
Mailing Address - Fax:
Practice Address - Street 1:370 SELBY AVE STE 316
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1965
Practice Address - Country:US
Practice Address - Phone:651-300-1729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5948101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health