Healthcare Provider Details

I. General information

NPI: 1477805265
Provider Name (Legal Business Name): ALEXANDRA A KRAAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

797 7TH ST E
SAINT PAUL MN
55106-5014
US

IV. Provider business mailing address

797 7TH ST E
SAINT PAUL MN
55106-5014
US

V. Phone/Fax

Practice location:
  • Phone: 651-379-4200
  • Fax: 651-292-0347
Mailing address:
  • Phone: 651-379-4200
  • Fax: 651-292-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: