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General NPI Number Information
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NPI Number | 1457748477
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Entity Type | Organization
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Legal Business Name | DR. ELLEN CHAZDON, PSY.D., L.P., LLC
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Dates
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Enumeration Date | 04/16/2015
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Last Update Date | 04/16/2015
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Provider Practice Location Address
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Address Line | 5200 WILLSON RD STE 490
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City | EDINA
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State | MN
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Zip | 55424-1398
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Country | US
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Telephone | 952-920-9304
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 WILLSON RD STE 490
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City | EDINA
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State | MN
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Zip | 55424-1398
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Country | US
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Telephone | 952-920-9304
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. ELLEN CHAZDON
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Credential | PSY.D., L.P.
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Telephone | 612-310-3318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3170
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License Number State | MN
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