Provider Demographics
NPI:1922762160
Name:FREITAG, ALEXANDRA ANNMARIE
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ANNMARIE
Last Name:FREITAG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXNANDRA
Other - Middle Name:ANNMARIE
Other - Last Name:PAULSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-2578
Mailing Address - Country:US
Mailing Address - Phone:507-469-8460
Mailing Address - Fax:
Practice Address - Street 1:135 FULTON ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-2578
Practice Address - Country:US
Practice Address - Phone:507-469-8460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst