Active NPI
Ellen Mary Manegold Stoltman, PHD
- Clinical Psychologist
- Grand Rapids, MI
National Provider Identifier
1194376053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301018734
- Practice address
- 25 Michigan St NE Ste 2200
Grand Rapids, MI 49503-2515 - Phone
- (616) 267-2850
- Fax
- (616) 267-9024
- NPI assigned
- Sep 23, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301018734 | MI | Primary |
Addresses
Primary practice location
25 Michigan St NE Ste 2200
Grand Rapids, MI 49503-2515
Mailing address
100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560
Other names 1
- Ellen Mary Manegold
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | emanegold271364@epic00.shdirect.org | ||
| FHIR URL | https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Interoperability endpoints
- estoltman271364@epic00.corewelldirect.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788912000000",
"number": "1194376053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 MICHIGAN ST NE # MC845",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495032560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 MICHIGAN ST NE STE 2200",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495032515",
"telephone_number": "616-267-2850",
"fax_number": "616-267-9024"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOLTMAN",
"first_name": "ELLEN",
"middle_name": "MARY MANEGOLD",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-23",
"last_updated": "2026-09-09",
"certification_date": "2026-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301018734",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "emanegold271364@epic00.shdirect.org",
"affiliation": "N",
"address_1": "35 Michigan St NE Ste 5201",
"city": "Grand Rapids",
"state": "MI",
"country_code": "US",
"postal_code": "495032530",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
"affiliation": "N",
"address_1": "35 Michigan St NE Ste 5201",
"city": "Grand Rapids",
"state": "MI",
"country_code": "US",
"postal_code": "495032530",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "ELLEN",
"last_name": "MANEGOLD",
"middle_name": "MARY",
"credential": "PHD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.