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Individual

ELLEN D. STODDARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
1722 PINE ST, 1ST FLOOR, PHILADELPHIA, PA 19103-6764
(215) 545-2655
Mailing address
1455 HAMPSTEAD RD, WYNNEWOOD, PA 19096-3105
(215) 545-2655

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS008455L
PA
103TC0700X
Clinical Psychologist
PS008455L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0495987000
INDEPENDENCE BLUE CROSS
PA
01
608672
HIGHMARK BLUE SHIELD
PA
Enumeration date
05/11/2007
Last updated
07/23/2007
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