Provider Demographics
NPI:1205335841
Name:MINKLER, ALEXANDRIA MICHELLE (BS, CT)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:MICHELLE
Last Name:MINKLER
Suffix:
Gender:F
Credentials:BS, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3839 S STATE ROAD 15
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-7975
Mailing Address - Country:US
Mailing Address - Phone:260-563-7696
Mailing Address - Fax:
Practice Address - Street 1:551 CINCINNATI BATAVIA PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-1518
Practice Address - Country:US
Practice Address - Phone:513-752-1555
Practice Address - Fax:513-752-1555
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC.1700699-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health