Healthcare Provider Details

I. General information

NPI: 1992503478
Provider Name (Legal Business Name): ALEXANDRA WULBECKER MED, MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 METRO BLVD STE 510
EDINA MN
55439-3033
US

IV. Provider business mailing address

9637 4TH STREET LN N
LAKE ELMO MN
55042-4524
US

V. Phone/Fax

Practice location:
  • Phone: 952-835-8513
  • Fax:
Mailing address:
  • Phone: 847-337-2107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC03753
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: