Healthcare Provider Details

I. General information

NPI: 1285859157
Provider Name (Legal Business Name): ELLEN B SNOXELL PH.D., L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UNIVERSITY AVE E
SAINT PAUL MN
55101-2507
US

IV. Provider business mailing address

GILLETTE CHILDREN'S SPECIALTY HEALTHCARE 200 UNIVERSITY AVE E
SAINT PAUL MN
55101-2507
US

V. Phone/Fax

Practice location:
  • Phone: 651-229-3855
  • Fax: 651-602-6891
Mailing address:
  • Phone: 651-229-3855
  • Fax: 651-602-6891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberLP2755
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP2755
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: