Provider Demographics
NPI:1851571145
Name:STILLMAN, ALEXANDRA MICHELE (PHD, MBA, MHA, MPH)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:MICHELE
Last Name:STILLMAN
Suffix:
Gender:F
Credentials:PHD, MBA, MHA, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2399 ARIEL ST N
Mailing Address - Street 2:SUITE D
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2203
Mailing Address - Country:US
Mailing Address - Phone:651-770-1311
Mailing Address - Fax:651-770-1879
Practice Address - Street 1:2399 ARIEL ST N
Practice Address - Street 2:SUITE D
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2203
Practice Address - Country:US
Practice Address - Phone:651-770-1311
Practice Address - Fax:651-770-1879
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4872103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical