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General NPI Number Information
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NPI Number | 1063929677
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Entity Type | Individual
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Provider Name | ALEXANDRA BLONIGEN BA, LADC
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Gender | Female
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 01/04/2018
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Provider Practice Location Address
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Address Line | 105 6TH AVE S
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City | PRINCETON
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State | MN
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Zip | 55371-1819
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Country | US
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Telephone | 763-308-0006
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Fax | 763-631-0339
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Provider Business Mailing Address
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Address Line | 23137 TAMARACK ST NW
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City | SAINT FRANCIS
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State | MN
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Zip | 55070-9625
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Country | US
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Telephone | 612-388-9129
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 304562
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License Number State | MN
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