Provider Demographics
NPI:1972755114
Name:MAISTROVICH, JESSE LEAF (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:LEAF
Last Name:MAISTROVICH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5125 COUNTY ROAD 101
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-4156
Mailing Address - Country:US
Mailing Address - Phone:952-932-7277
Mailing Address - Fax:952-932-9827
Practice Address - Street 1:5125 COUNTY ROAD 101
Practice Address - Street 2:SUITE 300
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4156
Practice Address - Country:US
Practice Address - Phone:952-932-7277
Practice Address - Fax:952-932-9827
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNCC01058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional