| Doctor Name: | MS. JESSICA E LEADHOLM |
| NPI Number: | 1194012724 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSCFYSLP |
| License Number: | 8729 |
| Business Practice Address: | 77 Milton St N Apt 105 Saint Paul, MN - 551047029 |
| Business Phone Number: | 6515874896 |
| Business Fax Number: | |
| Mailing Address: | 77 Milton St N Apt 105, SAINT PAUL |
| State: | MN |
| Postal Code: | 551047029 |
| Phone Number: | 6515874896 |
| Fax Number: | |
| NPI Enumeration Date: | 07/04/2011 |
| NPI Last Update Date: | 07/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 8729 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |