Ellen Chazdon, PSY D LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3170 Issued in MN

Practice address

5100 Eden Ave
Suite 117
Edina, MN 55436-2337

Phone

(952) 920-9304

Fax

(952) 920-9304

NPI assigned

Jul 7, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Previously, effective Oct 5, 2022 through Oct 5, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr. Ellen Chazdon, Psy.D., L.P., LLC

  • Clinical Psychologist
  • Edina, MN
  • NPI 1457748477
  Authorized official Same address or phone
• Maple Grove Counseling Center PA

  • Psychologist
  • Maple Grove, MN
  • NPI 1164496071
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205868635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 EDEN AVE",
            "address_2": "SUITE 117",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554362337",
            "telephone_number": "952-920-9304",
            "fax_number": "952-920-9304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 EDEN AVE",
            "address_2": "SUITE 117",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554362337",
            "telephone_number": "952-920-9304",
            "fax_number": "952-920-9304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAZDON",
        "first_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "PSY D LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "3170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEFINITY",
            "identifier": "24725",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "76D36BR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH",
            "identifier": "6178275",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7954181",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "108515",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Umar Shafique Chaudhry, MBBS
• Geraldine Chavis, MA
• Kenneth Marshall Chavis, PH.D.
• Puja Bharucha Chawla, MD
• Yair Chaya, MD
• Chemical Health Concepts, Inc. (Muscala Chemical Health Clinic)
• George Anthony Chen Jr., MD
• James Chuen-Chieh Chen, MD
• Sam Siu Lun Cheng, MD
• Trokon Lasanna Chenoweth

• Psychologist in Edina, MN
• Providers in Edina, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.