Healthcare Provider Details

I. General information

NPI: 1144974221
Provider Name (Legal Business Name): ALEXANDRA ZICKERMANN MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9298 CENTRAL AVE NE STE 310
BLAINE MN
55434-4219
US

IV. Provider business mailing address

245 RUTH ST N STE 101
SAINT PAUL MN
55119-4409
US

V. Phone/Fax

Practice location:
  • Phone: 651-955-4633
  • Fax: 651-440-9827
Mailing address:
  • Phone: 651-955-4633
  • Fax: 651-440-9827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3169
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: