Healthcare Provider Details

I. General information

NPI: 1750087912
Provider Name (Legal Business Name): ALEXANDRA REHOVSKY-BENNEWITZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 6TH AVE N
SAINT CLOUD MN
56303-2736
US

IV. Provider business mailing address

615 NELSON DR
CLEARWATER MN
55320
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-2700
  • Fax:
Mailing address:
  • Phone: 320-558-2293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071011176
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: