Provider Demographics
NPI:1457009730
Name:LEAF, NIKOLAS GREGORY
Entity type:Individual
Prefix:
First Name:NIKOLAS
Middle Name:GREGORY
Last Name:LEAF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 LOFTUS LN
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2717
Mailing Address - Country:US
Mailing Address - Phone:952-952-6120
Mailing Address - Fax:952-952-6121
Practice Address - Street 1:5725 LOFTUS LN
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2717
Practice Address - Country:US
Practice Address - Phone:952-952-6120
Practice Address - Fax:952-952-6121
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist