Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | LP2755 | MN |
Y | 103TC0700X | Clinical Psychologist | LP2755 | MN |
N | 103TR0400X | Rehabilitation Psychologist | LP2755 | MN |
NPI | 1285859157 |
---|---|
Provider Name | Dr. Ellen B Snoxell |
First Address | Saint Paul, MN 55101-2507 |
Second Address | Saint Paul, MN 55101-2507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 27/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
680003285 | MEDICARE PART B (01) | MN |