Provider Demographics
NPI:1639889033
Name:THOSTENSON, ALEXANDRAEANA
Entity Type:Individual
Prefix:
First Name:ALEXANDRAEANA
Middle Name:
Last Name:THOSTENSON
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 1:75693 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMING PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55917-6937
Mailing Address - Country:US
Mailing Address - Phone:507-676-1499
Mailing Address - Fax:
Practice Address - Street 1:300 11TH AVE NW STE 112
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2739
Practice Address - Country:US
Practice Address - Phone:225-507-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306404101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)