Provider Demographics
NPI:1831640952
Name:ST. CLAIR, ALLEXENDRA I
Entity Type:Individual
Prefix:
First Name:ALLEXENDRA
Middle Name:I
Last Name:ST. CLAIR
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 1:2809 GREAT NORTHERN LOOP STE 300
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1749
Mailing Address - Country:US
Mailing Address - Phone:406-546-2301
Mailing Address - Fax:406-630-4002
Practice Address - Street 1:2809 GREAT NORTHERN LOOP STE 300
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1749
Practice Address - Country:US
Practice Address - Phone:406-546-2301
Practice Address - Fax:406-630-4002
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13497104100000X
MTC1021925-10400509104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7220135Medicaid