Healthcare Provider Details

I. General information

NPI: 1679408405
Provider Name (Legal Business Name): STEPHANIE CORPE ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 12TH STREET NORTH MIDSOTA BEHAVIORAL HEALTH SUITE 206
SAINT CLOUD MN
56303
US

IV. Provider business mailing address

3701 12TH STREET NORTH MIDSOTA BEHAVIORAL HEALTH SUITE 206
SAINT CLOUD MN
56303
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-4918
  • Fax:
Mailing address:
  • Phone: 320-229-4918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33322
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: