Provider Demographics
NPI:1528169554
Name:KLEMPNAUER, STACEY LEIGH (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:LEIGH
Last Name:KLEMPNAUER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 SUMNER ST E
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2843
Mailing Address - Country:US
Mailing Address - Phone:507-645-0444
Mailing Address - Fax:
Practice Address - Street 1:220 DIVISION ST S
Practice Address - Street 2:SUITE 301
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2046
Practice Address - Country:US
Practice Address - Phone:507-645-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN176141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN51-0590572OtherFEIN
MN528658100Medicaid