Unknown Individual – Clinical Neuropsychologist, NPI 1891794855

Unknown Individual is a healthcare provider. based in Edina, Minnesota. specializing in CLINICAL PSYCHOLOGIST. They hold a License No. LP4457 (MN). The NPI Number for Unknown Individual is 1891794855

Main info

Organization
Inactive
36 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1891794855
Phone
(952) 746-4014
Address
3209 WEST 76TH STREET #207
Deactivation Date
14 October 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1990 (36 years ago)
PAC ID
7315851326
Professional Enrollment ID
I20031114000136
Address ID
MN554355246ED3209XSTXX402
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

1,110 CLINICAL PSYCHOLOGIST in MN

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Provider Addresses for Unknown Individual

  • West 76th Street, Centennial Lakes, Edina, Hennepin County, Minnesota, 55423, United States

    EDINA, MN 554355246

    Phone: (952) 746-4014

    Fax: (952) 746-4015

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
96137Administration of psychological or neuropsychological test, each additional 30 minutes8131$0
96132Evaluation of neuropsychological test, first hour3333$0
96136Administration of psychological or neuropsychological test, first 30 minutes3232$0
90791Psychiatric diagnostic evaluation3131$0
View full utilization report →

Insurance plans in this area (ZIP 55435)

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Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1891794855 for Unknown Individual, then check state licensing separately.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Clinical Neuropsychologist. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Edina, Minnesota in our summary view.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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