Healthcare Provider Details

I. General information

NPI: 1316709983
Provider Name (Legal Business Name): ALEXIS LANGENFELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 12/22/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 31ST AVE S STE A
FARGO ND
58104-7743
US

IV. Provider business mailing address

1047 PRAIRIE RIDGE LN
LESTER PRAIRIE MN
55354-7985
US

V. Phone/Fax

Practice location:
  • Phone: 701-478-0221
  • Fax:
Mailing address:
  • Phone: 320-510-5539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: