Provider Demographics
NPI:1467078105
Name:KATZKA, ALEXANDER JAMES
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JAMES
Last Name:KATZKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 SOUTHCROSS DR W
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-6945
Mailing Address - Country:US
Mailing Address - Phone:952-491-9810
Mailing Address - Fax:
Practice Address - Street 1:901 CALEDONIA ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-2616
Practice Address - Country:US
Practice Address - Phone:608-785-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst