Individual
DR. ALEKSANDRA WANTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
319TH MEDICAL GROUP, 1599 J STREET, GRAND FORKS AFB, ND 58205
(701) 747-4460
Mailing address
1599 J ST, GRAND FORKS AFB, ND 58205-6306
(701) 747-4460
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
10734
MA
103TC0700X
Clinical Psychologist
Primary
10734
MA
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Enumeration date
03/17/2015
Last updated
09/30/2020
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