Healthcare Provider Details

I. General information

NPI: 1528169554
Provider Name (Legal Business Name): STACEY LEIGH KLEMPNAUER MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 STATE AVE
FARIBAULT MN
55021-6337
US

IV. Provider business mailing address

312 SUMNER ST E
NORTHFIELD MN
55057-2843
US

V. Phone/Fax

Practice location:
  • Phone: 507-334-3921
  • Fax: 507-384-4470
Mailing address:
  • Phone: 507-645-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17614
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: