Organization
DR. ELLEN CHAZDON, PSY.D., L.P., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLEN CHAZDON PSY.D., L.P. (LICENSED PSYCHOLOGIST)
(612) 310-3318
Entity
Organization
Contact information
Practice address
5200 WILLSON RD STE 490, EDINA, MN 55424-1398
(952) 920-9304
Mailing address
5200 WILLSON RD STE 490, EDINA, MN 55424-1398
(952) 920-9304
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3170
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
720817100
—
MN
Enumeration date
04/16/2015
Last updated
04/16/2015
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