Provider Demographics
NPI:1437239308
Name:KUNIN-BATSON, ALICIA (PHD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:KUNIN-BATSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-365-6777
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-365-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4594103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0493408Medicaid
MN632T2KUOtherBCBS
IA0716860Medicaid
2393328OtherARAZ
MN86913-1OtherFAIRVIEW CAREGIVER
MN177907900Medicaid
MNB673OtherCHAMPUS
MN1046052OtherPREFERRED ONE
136699OtherU CARE
MNHP56958OtherHEALTH PARTNERS
MN86913-1OtherFAIRVIEW CAREGIVER