1346850518 NPI number — STACEY KLEMPNAUER MSW, LICSW INC

Table of content: DAVID ALEXANDER BARCLAY LCSW-C (NPI 1407051626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346850518 NPI number — STACEY KLEMPNAUER MSW, LICSW INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STACEY KLEMPNAUER MSW, LICSW INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346850518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1904 MICHIGAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHFIELD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55057-4834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-645-0444
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHFIELD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55057-5190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-645-0444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KLEMPNAUER
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
LEIGH
Authorized Official Title or Position:
PSYCHOTHERAPIST
Authorized Official Telephone Number:
507-645-0444

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 528658100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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