Provider Demographics
NPI:1912738832
Name:BOYSEN, STACEY LYNN
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:BOYSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:CROWSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:904 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:KASSON
Mailing Address - State:MN
Mailing Address - Zip Code:55944-1696
Mailing Address - Country:US
Mailing Address - Phone:507-244-0398
Mailing Address - Fax:
Practice Address - Street 1:1880 AUSTIN RD STE 1
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-4544
Practice Address - Country:US
Practice Address - Phone:507-214-2016
Practice Address - Fax:507-214-2017
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN228111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical