Individual
JACOB ALDEN LEBSACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2637 27TH AVE S # 248, MINNEAPOLIS, MN 55406-1565
(612) 208-8382
Mailing address
2637 27TH AVE S # 248, MINNEAPOLIS, MN 55406-1565
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6631031
MN
Other
Enumeration date
03/22/2023
Last updated
03/22/2023
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