Provider Demographics
NPI:1477805265
Name:KRAAK, ALEXANDRA A
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:A
Last Name:KRAAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 7TH ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-5014
Mailing Address - Country:US
Mailing Address - Phone:651-379-4200
Mailing Address - Fax:651-292-0347
Practice Address - Street 1:797 7TH ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-5014
Practice Address - Country:US
Practice Address - Phone:651-379-4200
Practice Address - Fax:651-292-0347
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)