Provider Demographics
NPI:1316472749
Name:ENGLUND, STACY M (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:ENGLUND
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:M
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:345 MERRIAM AVE N
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-2333
Mailing Address - Country:US
Mailing Address - Phone:218-416-2682
Mailing Address - Fax:
Practice Address - Street 1:1571 HIGHWAY 59 S STE 2
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-3413
Practice Address - Country:US
Practice Address - Phone:218-416-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN219781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical