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General NPI Number Information
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NPI Number | 1578637534
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Entity Type | Individual
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Provider Name | KEVIN H BLONIGEN M.A., L.P.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 500 MARSCHALL RD STE 100
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City | SHAKOPEE
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State | MN
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Zip | 55379-2689
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Country | US
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Telephone | 952-856-3932
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Fax | 952-448-6047
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Provider Business Mailing Address
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Address Line | 500 MARSCHALL RD STE 300
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City | SHAKOPEE
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State | MN
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Zip | 55379-2690
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Country | US
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Telephone | 952-856-3932
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Fax | 952-448-6047
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP3981
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License Number State | MN
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