Provider Demographics
NPI:1043025539
Name:STAFFORD, ALEXANDRIA NICOLE
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:NICOLE
Last Name:STAFFORD
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 1:8942 SE VANDALIA DR
Mailing Address - Street 2:
Mailing Address - City:RUNNELLS
Mailing Address - State:IA
Mailing Address - Zip Code:50237-2009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 S 68TH ST STE 1202
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8176
Practice Address - Country:US
Practice Address - Phone:515-346-3069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA127090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health