Healthcare Provider Details

I. General information

NPI: 1568377646
Provider Name (Legal Business Name): ALEXANDRA BUCKNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E EISENHOWER PKWY STE 300
ANN ARBOR MI
48108
US

IV. Provider business mailing address

1099 FAIRDALE GLN
FARMINGTON NY
14425-8996
US

V. Phone/Fax

Practice location:
  • Phone: 585-506-7385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801113553
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: