Provider Demographics
NPI:1386713071
Name:LEOPOLD, JENNIFER AVERY (MSW LICSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AVERY
Last Name:LEOPOLD
Suffix:
Gender:F
Credentials:MSW LICSW
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Other - First Name:
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Mailing Address - Street 1:2304 OLIVER AVENUE SOUTH
Mailing Address - Street 2:JENNIFER LEOPOLD LICSW
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405
Mailing Address - Country:US
Mailing Address - Phone:612-718-9327
Mailing Address - Fax:612-822-4477
Practice Address - Street 1:3133 HENNEPIN AVE SO
Practice Address - Street 2:JENNIFER LEOPOLD LICSW
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408
Practice Address - Country:US
Practice Address - Phone:612-718-9327
Practice Address - Fax:612-822-4477
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN104811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6249141OtherUBH MEDICA
MN385S7LEOtherBLUE CROSS BLUE SHIELD