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

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3170 Issued in MN

Legal business name

DR. ELLEN CHAZDON, PSY.D., L.P., LLC

Practice address

5200 Willson Rd Ste 490
Edina, MN 55424-1398

Phone

(952) 920-9304

NPI assigned

Apr 16, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Ellen Chazdon, PSY.D., L.P.

Title

Licensed Psychologist

Phone

(612) 310-3318

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1429142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429142400000",
    "number": "1457748477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 WILLSON RD STE 490",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554241398",
            "telephone_number": "952-920-9304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 WILLSON RD STE 490",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554241398",
            "telephone_number": "952-920-9304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. ELLEN CHAZDON, PSY.D., L.P., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-16",
        "last_updated": "2015-04-16",
        "status": "A",
        "authorized_official_last_name": "CHAZDON",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "612-310-3318",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D., L.P."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "3170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "720817100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.