Individual
DR. ELLEN CHAZDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY D LP
Contact information
Practice address
5100 EDEN AVE, SUITE 117, EDINA, MN 55436-2337
(952) 920-9304
(952) 920-9304
Mailing address
5100 EDEN AVE, SUITE 117, EDINA, MN 55436-2337
(952) 920-9304
(952) 920-9304
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3170
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108515
UCARE
MN
01
—
24725
DEFINITY
MN
01
—
6178275
UBH
—
01
—
76D36BR
BCBS
MN
01
—
7954181
AETNA
MN
Enumeration date
07/07/2006
Last updated
07/08/2007
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