| NPI | 1457748477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLEN CHAZDON Licensed Psychologist 612-310-3318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 3170) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2015-04-16 |