Individual
MS. JESSICA E LEADHOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSCFYSLP
Contact information
Practice address
77 MILTON ST N APT 105, SAINT PAUL, MN 55104-7029
(651) 587-4896
Mailing address
77 MILTON ST N APT 105, SAINT PAUL, MN 55104-7029
(651) 587-4896
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3487-154
WI
235Z00000X
Speech-Language Pathologist
8729
MN
Other
Enumeration date
07/04/2011
Last updated
07/04/2011
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