Provider Demographics
NPI:1285859157
Name:SNOXELL, ELLEN B (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:B
Last Name:SNOXELL
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Mailing Address - Street 2:200 UNIVERSITY AVE E
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2507
Mailing Address - Country:US
Mailing Address - Phone:651-229-3855
Mailing Address - Fax:651-602-6891
Practice Address - Street 1:200 UNIVERSITY AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2507
Practice Address - Country:US
Practice Address - Phone:651-229-3855
Practice Address - Fax:651-602-6891
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2755103TR0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN680003285OtherMEDICARE PART B