MEDICARE: ALEXANDRA WULBECKER MED, MA, LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	CC03753	MN

General Provider Information

NPI Number	:	1992503478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA WULBECKER MED, MA, LPCC

Provider Business Mailing Address
First Line	:	9637 4TH STREET LN N
Second Line	:
City	:	LAKE ELMO
State	:	MN
Zip	:	55042-4524
Country	:	US
Telephone Number	:	847-337-2107
Fax Number	:

Provider Business Practice Location Address
First Line	:	7401 METRO BLVD STE 510
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55439-3033
Country	:	US
Telephone Number	:	952-835-8513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2025
Last Update Date	:	03/03/2025

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