Healthcare Provider Details

I. General information

NPI: 1275137739
Provider Name (Legal Business Name): STACEY NICHOLE RHYNER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 HAYWARD AVE N
OAKDALE MN
55128-5379
US

IV. Provider business mailing address

434 HAYWARD AVE N
OAKDALE MN
55128-5379
US

V. Phone/Fax

Practice location:
  • Phone: 218-398-2639
  • Fax:
Mailing address:
  • Phone: 218-398-2639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29417
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: